腹主动脉瘤腔内修复术后发生髂支闭塞的危险因素及处理对策  

Risk factors and management for iliac branch occlusion after endovascular abdominal aortic aneurysm repair

作　　者：王浙宇 许懿 赵昌波 杨硕菲[1] 倪其泓[1] 陈佳佺[1] 王韦仑 李一男[1] 郭相江[1] 叶猛[1] 张岚[1] 薛冠华[1] WANG Zheyu;XU Yi;ZHAO Changbo;YANG Shuofei;NI Qihong;CHEN Jiaquan;WANG Weilun;LI Yinan;GUO Xiangjiang;YE Meng;ZHANG Lan;XUE Guanhua(Department of Vascular Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院血管外科,上海200127

出　　处：《山东大学学报（医学版）》2024年第9期101-107,共7页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(82370497)。

摘　　要：目的 分析腹主动脉瘤主动脉腔内修复术(endovascular aortic repair, EVAR)后发生髂支闭塞的危险因素及处理对策。方法 收集上海交通大学医学院附属仁济医院2021年1月至2023年5月期间收治的191例接受EVAR的腹主动脉瘤患者的临床资料。采用病例对照匹配设计,根据性别、年龄和所使用的支架的商业类型按照1∶2比例将发生髂支闭塞与未发生髂支闭塞的病例进行匹配,作为病例组(n=26)和对照组(n=52)。采用单因素和条件Logistic回归,分析病例组与对照组相比发生髂支闭塞的危险因素。对髂支闭塞进行吸栓溶栓、球囊扩张或支架植入处理。结果 EVAR术后13.61%(26/191)患者发生髂支闭塞并进行相应处理,其中1例患者在1个月后对侧再次出现髂支闭塞,2例患者吸栓后予以继续溶栓1 d后进行球囊扩张,所有患者术后髂动脉恢复血流。条件Logistic回归分析显示腹主动脉分叉直径<20 mm(OR=4.544,95%CI:1.397~14.779)、术前髂总动脉严重扭曲(OR=5.971,95%CI:1.528~23.336)及髂总动脉钙化>50%(OR=4.165,95%CI:1.189~14.587)与髂支闭塞相关。结论 腹主动脉直径<20 mm、术前髂总动脉严重扭曲和髂总动脉钙化>50%可能是EVAR术后髂支闭塞的独立危险因素。髂支闭塞经吸栓、球囊扩张或支架植入后可以得到明显改善。Objective To analyze the risk factors of iliac branch occlusion after endovascular aneurysm repair(EVAR)for abdominal aortic aneurysm and the countermeasures.Methods Clinical data of 191 patients with abdominal aortic aneurysm undergoing EVAR admitted to Renji Hospital,Shanghai Jiaotong University School of Medicine between January 2021 and May 2023 were collected.Using a case-control matched design,the cases with and without iliac branch occlusion were matched in a 1∶2 ratio according to gender,age and commercial type of stent used,as the case group(n=26)and control group(n=52).Univariate and conditional Logistic regression analysis was conducted to analyze the risk factors of iliac branch occlusion in the case group compared with the control group.Iliac branch occlusion was treated with thrombolysis,balloon dilatation or stent implantation.Results Iliac branch occlusion occurred in 13.61%(26/191)of the patients after EVAR,and the corresponding treatment was carried out.Among them,1 patient had another limb occlusion in the contralateral side after 1 month,and 2 patients were given continuation of thrombolysis after thrombus aspiration for 1 day and then balloon dilatation was performed.All patients recovered blood flow from iliac artery after operation.Conditional Logistic regression analysis showed that abdominal aortic bifurcation diameter<20 mm(OR=4.544,95%CI:1.397-14.779),preoperative severe distortion of iliac artery before operation(OR=5.971,95%CI:1.528-23.336)and calcification of common iliac artery>50%(OR=4.165,95%CI:1.189-14.587)were associated with iliac branch occlusion.Conclusion Abdominal aorta diameter<20 mm,severe preoperative distortion of common iliac artery,and calcification of common iliac artery>50%may be independent risk factors for iliac branch occlusion after EVAR.It can be improved obviously after embolectomy,balloon dilatation or stent implantation.

关 键 词：腹主动脉瘤 腔内治疗 移植物闭塞 危险因素 病例对照研究 

分 类 号：R543.1[医药卫生—心血管疾病]