A Comparative Study Of Reconstructive Methods Of Internal Iliac Artery During Endovascular Repair Of Iliac Aneurysms

Objective: To investigate the advantages and disadvantages of different surgical methods for reconstruction of internal iliac artery in abdominal aortic aneurysm with radial aneurysm and solitary common iliac artery aneurysm.To provide a clinical basis for intraoperative reconstruction of internal iliac arteries.Methods: A retrospective analysis was performed on the clinical data of patients with abdominal aortic aneurysm with radial artery aneurysm and isolated common iliac artery aneurysm who underwent endovascular repair during the 2013-2017 period of vascular surgery in the General Hospital of Tianjin Medical University.According to different surgical methods,the patients were divided into the "IBD branch device IBD" group and the "sandwich stent" group.Preoperative,intraoperative,perioperative,and follow-up were compared between the two groups.RESULTS: A total of 16 patients,including 15 male patients and 1 female patient,aged 50-80 years,mean 67±7.31 years old,IBD group(study group)9 cases,and sandwich group(control group)7 cases.During the follow-up period,patients were contacted by telephone and the clinic examined the main abdominal CTA.The time ranged from one month to December.The technical success rate of IBD group was 77.78%,2 cases of IBD insertion failed,the technical success rate of the sandwich group was 85.71%,and intraoperative type III endoleak occurred in 1 case(P=0.600).The clinical success rate in the IBD group was 77.78%.Two patients had gluteal muscle spasm after surgery.The success rate of the sandwich group was 100%(P=0.475).The incidence of endoleak after operation was 0% in the IBD group,14.29% in the sandwich group,and 1 in the Gutter endoleak(P=0.438).The branch patency rate was 100% in the IBD group,71.43% in the sandwich group,and 2 cases in the fistula(P=0.175).External iliac artery bare stent implantation rate: In the IBD group,1 bare stent was implanted,the implantation rate was 11.11%,and 3 bare stents were implanted in the sandwich group,and the implantation rate was 42.86%(P=0.262).Perioperative complications: 1 in the IBD group had radial arterial puncture point bleeding,11.11%,and 0% in the sandwich group(P=0.563).There was no statistically significant difference in the above observations between the IBD group and the sandwich group.Re-intervention rate: In the IBD group,no reoperation was performed in 1 patient,57.14% in the sandwich group,1 in the endoleak,2 in the thrombolysis,and 1 in the thrombectomy(4/7)(P=0.019).There was a statistically significant difference between the IBD group and the sandwich group.CONCLUSIONS: IBD is an ideal technique for reconstructing IIA blood flow and is applicable to anatomy and hemodynamics.It can be used for the treatment of abdominal aortic aneurysms with radial aneurysms or isolated common iliac artery aneurysms.However,users need to go through a certain learning curve and have a clear understanding of anatomical indications.