摘要
目的观察腹主动脉瘤腔内修复术(EVAR)封闭髂内动脉后臀肌和下肢缺血情况。方法回顾性分析2006年1月～2011年1月在我院行EVAR术的174例患者的临床资料。腹主动脉瘤最大直径[(55.2±12.9)mm],累及髂总动脉52例(29.9%)。EVAR治疗方法包括置入分叉型覆膜支架169例(97.1%),单臂型5例(2.9%)。术中封闭单侧髂内动脉29例,封闭双侧髂内动脉10例。观察围手术期和随访期患者臀肌和下肢发生缺血情况。结果行EVAR术的174例患者中,173例手术顺利,无中转开腹,1例术中死亡,1例术后死亡。术中封闭单侧髂内动脉29例中有2例出现同侧臀肌轻度疼痛,行走疼痛加重,跛行距离100m,5例出现同侧下肢乏力,间歇性跛行100～200m;封闭双侧髂内动脉10例中有4例术后出现臀肌轻度疼痛,跛行距离200m,均采用扩血管、祛聚保守治疗后2～4周疼痛症状好转,间歇性跛行距离均大于500m,无臀肌坏死发生,无再行介入或外科干预治疗,随访期间跛行距离逐渐增加500～1000m,余未诉特殊不适。结论 EVAR术封闭髂内动脉后臀肌和下肢不同程度缺血,经保守扩血管和祛聚治疗可以缓解,但一定程度会影响患者生活质量,封闭双侧髂内动脉或一侧均应宜慎重。
Objective To observe the outcome following exclusion of internal iliac artery during endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA). Methods The clinical data of 174 patients with AAA who underwent EVAR from January 2006 to January 2011were analyzed retrospectively. The max diameter of AAA was (55.2±12.9)mm, and common iliac arteries of 52 cases (29.9%) were involved. Bifurcated stent grafts and tubular stent grafts were placed in 169 (97.1%) and 5 cases (2.9%), respectively. Unilateral and bilateral internal iliac arteries were closed in 29 and 10 cases during operation, respectively. During peri-operation and follow-up period, the patients who developed gluteal and lower limb ischemia should be recorded. Results Of 174 cases, EVAR successed in 173 cases without conversion to open surgery. And 1 case died during the operation and 1 died after the operation. Of 29 cases who were closed unilateral internal iliac artery,mild ipsilateral gluteal pain and pain worsened occurred in 2 cases after walking with claudication distance of 100 meters, and 5 cases occurred ipsilateral lower limb fatigue with claudication distance of 100～200 meters. Of 10 cases who were closed bilateral internal iliac arteries, mild gluteal pain with claudication distance of 200 meters occurred in 4 cases, and their symptoms improved and claudication distance was more than 500 meters after conservative treatment. These 4 cases didn't develop gluteal gangrene and claudication distance increased 500～1000 meters during the follow-up period. Conclusions Various degress ischemia of gluteal and lower limb after closure of the internal iliac artery during EVAR can relieved by conservative treatment, but may affect the quality of life to a certain extent. Thus, seal of unilateral or bilateral internal iliac arteries should be careful, especially for bilateral internal iliac artery.
出处
《中国血管外科杂志（电子版）》
2012年第4期221-224,共4页
Chinese Journal of Vascular Surgery(Electronic Version)
关键词
腹主动脉瘤
腔内修复术
髂内动脉
Abdominal aortic aneurysm
Endovascular repair
Internal iliac artery
