置管溶栓结合覆膜支架治疗近肾主髂动脉闭塞性病变

目的:探讨置管溶栓结合覆膜支架腔内治疗近肾主髂动脉闭塞的疗效。方法:回顾性分析自2013年6月至2015年2月,采用置管溶栓结合覆膜支架行腔内血运重建的9例近肾主髂动脉闭塞病人,其中男7例,女2例,平均年龄(71.1±11.2)(54~87)岁。术后1、3、6及12个月随访复查,及主动脉CTA复查。结果:9例均置管溶栓24 h。8例成功置入Gore Excluder覆膜支架和对侧分支支架各1枚,其中1例加用延长肢1枚。1例采用Kissing技术置入Gore Viabahn覆膜支架3枚。随访(9.0±3.3)(3~16)个月。技术成功率100%。所有下肢缺血明显缓解。围手术期无死亡病例及严重并发症发生。未见支架移位及内漏发生,主髂动脉移植物通畅。仅1例因局部感染行左足趾截断术。结论:置管溶栓结合覆膜支架治疗近肾主髂动脉闭塞,近、中期效果良好。     

腔内修复术治疗孤立性髂动脉瘤7例分析

目的总结腔内修复术治疗孤立性髂动脉瘤的经验。方法回顾性分析2004年10月至2006年3月复旦大学附属中山医院血管外科收治的腔内修复孤立性髂动脉瘤7例的临床资料。其中,右髂总动脉瘤4例,左髂总动脉瘤2例,左髂内动脉瘤破裂1例。结果7例均取得技术成功。3例右髂总动脉瘤累及右髂内动脉,选用分叉支架型人工血管行腔内修复术。1例右髂总动脉瘤累及腹主动脉下端,选用AUI(Aortouniiliac)支架型人工血管腔内修复加股动脉旁路术。2例左髂总动脉瘤选用直型支架型人工血管。1例左髂内动脉瘤破裂急诊行钢圈栓塞后选用直型支架覆盖左髂内动脉开口。术后即刻数字减影血管造影(DSA)造影显示动脉瘤消失,远近端支架型人工血管与宿主动脉结合处均未见明显渗漏。1例术后出现急性左心功能不全和肺水肿,经抢救痊愈,其余6例无手术并发症。术后随访1～19个月(平均10.6±6.42个月),瘤体无增大,支架无移位,无内漏,旁路人工血管通畅。结论腔内修复术治疗孤立性髂动脉瘤具有可行、安全、微创等特点,近期疗效较好,远期效果尚须进一步随访。     

术中髂动脉支架结合股动脉旁路术治疗多节段动脉硬化闭塞症

目的 探讨术中髂动脉腔内成形及支架植入结合股-Guo动脉旁路术治疗多节段动脉硬化闭塞症的初步临床经验。方法 采用术中同时行髂动脉腔内成形和支架植入结合股-Guo动脉旁路术治疗多节段动脉硬化闭塞症10例（12条肢体）。结果 术中11条髂动脉行腔内成形和支架植入均获成功,9条肢体行股-Guo动脉人工血管旁路术,3条肢体行股-股-Guo动脉人工血管旁路系列转流术;1条肢体股-Guo动脉旁路术失败,本组患者无重要脏器并发症和手术死亡。平均随访时间6个月（1-12个月,髂动脉腔内支架通畅率100%;3条股-股动脉耻骨上人工血管转流均通畅;而股-Guo动脉人工血管通畅率83.3%;截肢率8.3%。结论 术中髂动脉腔内支架结合股-Guo动脉旁路术是治疗多节段动脉硬化闭塞症的安全、有效方法。     

腔内修复术治疗孤立性髂动脉瘤14例

目的探讨腔内治疗孤立性髂动脉瘤的疗效。方法回顾性分析2004年10月至2006年5月腔内修复孤立性髂动脉瘤14例的临床资料。其中,右髂总动脉瘤8例,左髂总动脉瘤5例,左髂内动脉瘤破裂1例。髂动脉瘤腔内修复的标准是瘤体直径〉3．0cm。结果14例均取得技术成功。8例右髂总动脉瘤,钢圈栓塞右髂内动脉后选用分叉支架型人工血管行腔内修复术。其中1例右髂总动脉瘤累及腹主动脉下端,选用AUl支架型人工血管腔内修复加股．股动脉旁路术。5例左髂总动脉瘤栓塞同侧髂内动脉后选用直型支架型人工血管。1例左髂内动脉瘤破裂急诊行钢圈栓塞后选用直型支架覆盖左髂内动脉开口。术后即刻数字减影血管造影显示动脉瘤消失,远近端支架型人工血管与宿主动脉结合处均未见明显渗漏。1例术后出现急性左心功能不全和肺水肿,经抢救痊愈,其余13例无手术并发症。术后CTA随访10．2个月（3～19个月）,瘤体无增大,支架无移位,无内漏,旁路人工血管通畅。结论腔内修复术治疗孤立性髂动脉瘤具有可行、安全、微创等特点,近期疗效较好,远期效果需进一步随访。     

主髂动脉闭塞的覆膜支架介入治疗

目的 总结覆膜支架在主髂动脉闭塞介入治疗中的应用经验.方法 45例主髂动脉闭塞患者,其中男37例,女8例,年龄38 ～ 94岁,平均(61±12)岁.临床表现间歇性跛行28例,静息痛11例,足趾坏疽6例.单侧髂动脉闭塞22例,一侧髂动脉闭塞合并对侧狭窄8例,主动脉及双侧髂动脉同时闭塞15例.病变长度6 ～18 cm,平均(12 ±3) cm.4例在介入溶栓3d后置人覆膜支架,其余病例均一期置入覆膜支架.结果 所有病例均成功完成操作,单侧放置覆膜支架19例,使用Kissing技术放置覆膜支架26例.所有病例术后下肢缺血症状均得到缓解,仅1例患者因感染最终截肢.随访6 ～21个月,平均(12±4)个月,除1例单侧髂动脉闭塞病例因远端流出道差于术后14个月闭塞外,其余支架均通畅,通畅率97.8％.结论 使用覆膜支架介入治疗主髂动脉闭塞,效果是满意的.     

术中自制髂动脉分支支架治疗主髂动脉瘤的单中心经验

目的:总结术中自制髂动脉分支支架(IBD)在主髂动脉瘤腔内修复术中保留髂内动脉的经验。方法:回顾性分析2018年1月至2018年12月在南京大学医学院附属鼓楼医院13例主髂动脉腔内修复术中使用自制髂动脉分支支架重建髂内动脉患者资料,其中2例重建双侧髂内动脉,11例单侧髂内动脉,术后观察盆腔缺血症状发生、髂内分支支架通畅率、有无内漏及瘤体扩张等情况。结果:应用自制IBD保留髂内动脉技术成功率为100%,术中出现2例Ⅲ型内漏,1例Ⅱ型内漏,围术期无其他并发症发生。术后平均随访9(4~12)个月,无瘤体扩张,支架内未见明显血栓形成,无瘤体相关性死亡,2例Ⅲ型内漏消失,1例Ⅱ型内漏持续存在,但瘤体无增大;IBD支架和髂内动脉通畅率为100%。1例对侧髂内栓塞患者术后出现对侧臀肌跛行,随访3个月后症状消失,无勃起、大小便功能障碍等症状出现。结论:术中自制IBD的应用是一种安全、有效的选择,近期效果理想,远期管腔通畅率还有待进一步随访。     

一体式分支型覆膜支架治疗腹主动脉-髂动脉分叉部病变的疗效分析

目的探讨一体式分支型支架在腹主动脉-髂动脉分叉部病变中的应用效果。方法回顾性收集2016年8月至2019年1月在首都医科大学附属北京世纪坛医院血管外科接受一体式分支型覆膜支架治疗的18例腹主-髂分叉部病变患者资料,分析其技术成功率和术后疗效。结果 17例患者成功植入一体式分支型覆膜支架系统,技术成功率94.4%。病例均成功使用预置血管缝合器成功封堵穿刺点,无穿刺点出血、假性动脉瘤、闭塞等并发症,平均住院时间(5.0±0.6)d。患者平均随访(13.0±3.0)个月,无支架相关死亡,无动脉瘤及支架移植物破裂,无支架移位。所有患者支架内血流通畅,无髂支闭塞病例,通畅率为100%。术后3个月发现Ⅱ型内漏1例,术后6个月复查时消失,未发现其他类型内漏。结论一体式分支型覆膜支架治疗腹主动脉-髂动脉分叉部病变安全有效,近中期疗效满意,但长期效果还有待进一步研究。     

TASCC、D级髂动脉病变的腔内治疗

目的探讨腔内技术治疗TASCC、D级髂动脉病变的可行性及近期疗效。方法回顾性总结77例TASCC、D级(共89条髂动脉)行腔内治疗患者的临床资料;其中TASCC级病变63例,TASCD级病变14例。结果 3条髂动脉未能开通闭塞段,开通率为96.6%。23条髂动脉行单纯经皮血管腔内成形术治疗,其余63条髂动脉置入支架。共置入支架104枚。踝肱指数由术前0.20±0.14增至术后7天的0.71±0.21(P=0.02)。主要并发症发生率3.9%。64例(78条髂动脉)患者获得随访,随访率83.1%;平均随访时间23(6～53)个月,其1、2、4年肢体通畅率分别为88%、84%和70%。结论腔内治疗TASCC、D级髂动脉病变安全微创,其短期效果较好。     

TAGC C、D级髂动脉病变的腔内治疗

目的 探讨腔内技术治疗TASC C、D级髂动脉病变的可行性及近期疗效.方法 回顾性总结77例TASCC、D级(共89条髂动脉)行腔内治疗患者的临床资料;其中TASC C级病变63例,TASC D级病变14例.结果 3条髂动脉未能开通闭塞段,开通率为96.6%.23条髂动脉行单纯经皮血管腔内成形术治疗,其余63条髂动脉置人支架.共置入支架104枚.踝肱指数由术前0.20±0.14增至术后7天的0.71±0.21(P=0.02).主要并发症发生率3.9%.64例(78条髂动脉)患者获得随访,随访率83.1%;平均随访时间23(6-53)个月,其1、2、4年肢体通畅率分别为88%、84%和70%.结论 腔内治疗TASC C、D级髂动脉病变安全微创,其短期效果较好.     

覆膜支架治疗肾下主髂动脉闭塞一例并文献复习

目的总结腔内治疗肾下主髂动脉闭塞的临床特点。方法对本院的1例TASC-ⅡD级肾下主髂动脉闭塞患者采用双覆膜支架的kissing技术进行治疗,并回顾性复习相关的腔内治疗文献。结果患者手术成功,间歇性跛行症状消失,术后复查CT血管造影显示支架位置形态良好顺利出院,术后半年门诊随访,彩超示支架内血流通畅,恢复良好。结论覆膜支架植入术已成为肾下主髂动脉闭塞的主流治疗方式,但还要遵循个体化治疗原则,采取个体化治疗。     

Isolated iliac artery aneurysms

Clinical and diagnostic data were collected from 22 men with iliac artery aneurysms treated surgically over a period of 22 years. Their ages ranged from 47 to 80 years (mean 64.0). Eight patients had multiple aneurysms. Thirty isolated iliac artery aneurysms were detected, 20 aneurysms (66.6%) located on the right and 10 (33.3%) on the left side. Twenty-six aneurysms were found in the common iliac artery (86.6%). Fifteen patients were symptomatic (68.2%); rupture occurred in five patients (22.7%), three of whom were initially asymptomatic. Thirteen of 17 patients whose aneurysms did not rupture had a palpable mass (76.4%), and three had bruits in the area of the aneurysm. All 22 patients were subjected to operative procedures. Seventeen patients operated upon electively survived, whereas only three patients who were operated upon after rupture survived. Graft interposition was the most common procedure. All 20 patients who survived after the operation were followed. Two died of myocardial infarction three and five years later, one of cancer six years later, and one of an unknown cause eight years after operation. Iliac artery aneurysms are extremely rare; their diagnosis is very difficult. The mortality rate is two times higher than in aortic aneurysms, once the diagnosis has been established. Therefore elective resection and arterial reconstruction are recommended.     

Retro-internal iliac artery ureter

We report a case of retro-internal iliac artery ureter which was managed initially by division and ligation of this vessel. Use of an omental pedicle to minimize scarring and adhesion at the site of previous ureteric obstruction was unsuccessful and additional surgery was required for definitive decompression.     

Isolated iliac artery aneurysms

Isolated aneurysms of the iliac arteries are extremely rare, comprising less than 2% of all aneurysmal disease. These aneurysms are typically seen in older men. Their natural history, although fairly indolent, carries a significant risk of rupture when the aneurysms have attained a large size. Their operative mortality is significantly higher when undertaken as an emergent versus elective procedure, underscoring the importance of early diagnosis and appropriate management. This article reviews the literature with regard to the natural history, diagnostic workup, and treatment of iliac artery aneurysms. For patients undergoing elective repair, preoperative imaging with computed tomography or magnetic resonance is advocated. Repair is recommended for good-risk patients with aneurysms larger than 3.5 cm. A working classification based on aneurysmal anatomy is provided along with an outline of the suggested open and endovascular surgical options. Results of open and endovascular strategies are summarized and follow-up recommendations are proposed.     

Endovascular treatment for long segment iliac artery occlusion involving the iliac artery opening

ObjectiveThis retrospective nonrandomized study investigated the outcomes of endovascular therapy for long-segment iliac artery occlusion involving the iliac artery opening.MethodsDuring a 5-year period (from Mar 2012 to Mar 2017), 32 patients (two women and 30 men; mean age, 69.0 years; range, 51–90 years) received endovascular therapy, with or without catheter-directed thrombolysis (CDT), for long-segment iliac artery occlusion (mean lesion length, 129.8 mm; range, 74.7–189.3 mm).ResultsThe technical success rate was 90.6% (29 of 32). The major complication rate was 3.5%, but no in-hospital mortality was recorded. The access site complication rate was 10.3%. The clinical symptoms of 29 patients were significantly improved. All 29 patients were followed up for 6–40 months, with an average of 16.7 ± 10.9 months. The primary patency rates were 96.6 ± 3.4% at 6 months, 86.6 ± 7.3% at 12 months, 79.4 ± 9.6% at 24 months, and 66.2 ± 14.5% at 36 months.ConclusionsDepending on the characteristics of the disease, endovascular treatment with an individualized, rational choice of approach and with fine-tuning of the operation is a safe and effective treatment for long-term iliac artery occlusion involving the opening of the iliac arteries. Customization of the treatment is also the key to a successful operation and to ensuring good postoperative efficacy.     

An anomalous right iliac artery presenting as iliac stenosis

An anatomical anomaly of pre-aortic inferior vena cava and retro-psoas iliac artery in a 33-year-old female is reported. This patient presented with severe right leg claudication and was successfully managed by implantation of an aortofemoral graft.     

Spontaneous iliac artery aneurysm-ureteric fistula

Isolated iliac artery aneurysms occur ten times less frequently than aortic aneurysms. Symptoms of compression of other pelvic structures may cause their presentation and occasionally they rupture into adjacent organs. We describe only the third case of spontaneous rupture of an isolated iliac aneurysm into a ureter which led to massive haematuria.