EVAR in which the Bilateral Limbs Extended into the External Iliac Arteries

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  • 両側外腸骨動脈へlanding させるEVAR における内腸骨動脈への処置

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Objectives: Endovascular aneurysm repair (EVAR) remains challenging in patients with bilateral iliac artery aneurysms. We evaluated the clinical outcomes of patients after EVAR in which the bilateral limbs extended into the external iliac arteries (EIAs), and after either revascularization of a unilateral internal iliac artery (IIA) or interruption of the bilateral IIAs. Methods: We retrospectively reviewed 21 patients with bilateral iliac aneurysms who underwent EVAR at our institution between June 1, 2008, and March 31, 2013. We basically reconstruct IIA on one side to treat aortoiliac aneurysms with bilateral iliac aneurysms. However, we sacrifice both IIAs if bilateral internal iliac artery aneurysms are evident or if the general condition of a patient is bad. Fourteen patients were treated by coil embolization to the unilateral IIA and a contralateral EIA-IIA bypass through the retroperitoneal approach and seven were treated by coil embolization to the bilateral IIAs. We compared hospital mortality, surgical duration, hospital stay, and ischemic complications between the two groups. Results: Mean surgical duration was shorter (p=0.01), and the mean amount of blood loss (p=0.04) as well as mean transfusion (p=0.03) were lower in the group with embolization to the bilateral IIAs than in the group that underwent IIA revascularization. Postoperative hospital stay, buttock pain, erectile dysfunction and ischemic colitis did not significantly differ between the two groups. However, one patient died of acute bowel ischemia. Conclusion: Coil embolization to the bilateral IIAs before EVAR is safe and acceptable for treating patients with bilateral iliac aneurysms. However, we recommend unilateral IIA revascularization unless patients are frail and have bilateral internal iliac aneurysms.

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