The CT And Clinical Research Of Blood Supply In The Pelvic Region With Embolization Of The Internal Iliac Artery In Abdominal Aortic Aneurysm Endovascular Repair

Objectives: Retrospective analysis the preoperative and postoperative CT images in patients with abdominal aortic aneurysm endovascular repair(EVAR)to exploring the possibility of preoperative assessment of blood supply in the pelvic region with bilateral or unilateral internal iliac artery(IIA)embolization in EVAR.And whether the changing trends of blood supply in the pelvic region after embolization of bilateral or unilateral IIA in EVAR can provide objective basis to provide a clinical reference for avoiding severe pelvic ischemic complications after EVAR.Methods: The hospitalized patients diagnosed as AAA at the Department of Interventional Vascular Surgery at the First Affiliated Hospital of Jinan University from December 2012 to December 2017 were divided into three groups according to the different treatment of IIA during EVAR: bilateral IIA embolization group a nd unilateral IIA embolization group and retention of bilateral IIA group,11 patients in bilateral IIA embolization group,9 males and 2 females,aged 66-80 years,with an average of 73±5 years old,9 patients were included in the unilateral IIA embolization group,6 males and 3 females,aged 69-89 Years old,average 76±6 years old;12 patients with bilateral IIA retained group,all male,aged 34-84 years,mean 62±15 years old;blood vessels of the pelvic region after bilateral IIA embolization group and unilateral IIA embolization group were counted,and the common pelvic region blood vessels were selected after EVAR operation embolization IIA.After diameter measurement of selected vessels preoperative and postoperative,t-test was used for statistical analysis,and the collateral circulation after EVAR embolization IIA was analyzed.Results: 1.After embolization IIAs in EVAR,the most common of blood vessels of the pelvic region are: inferior mesenteric artery,inferior epigastric artery,deep iliac circumflex artery,superficial iliac circumflex artery,external pudendal artery,medial femoral circumflex artery,ascending branch of lateral circumflex femoral artery.2.The comparison of preoperative and postoperative of the inferior mesenteric artery,inferior epigastric artery,deep iliac circumflex artery,superficial iliac circumflex artery,external pudendal artery,medial femoral circumflex artery and ascending branch of lateral circumflex femoral artery in bilateral IIA embolization and ambulatory IIA group: the vessels in bilateral IIA embolization group was significantly thicker than the before of operation with statistical significance,the P <0.05,the average blood vessel diameters before and after surgery: 2.30±0.49 mm,2.28±0.47 mm,1.95±0.44 mm,1.98±1.00 mm,2.05±1.00 mm,2.24±0.59 mm,2.18±0.55 mm and 2.60±0.55 mm,2.87±0.46 mm,2.34±0.41 mm,2.26±1.04 mm,2.34±1.07 mm,2.70±0.54 mm,2.51±0.67 mm.while the retention and preservation of bilateral IIA group had little change in preoperative and postoperative blood vessel diameters.Except for the inferior epigastric artery,Mean blood vessel diameter before and after surgery: 2.40±0.26 mm,2.47±0.23 mm P >0.05.3.There were a statistically significant difference in vessel diameter between the inferior epigastric artery,deep iliac circumflex artery,medial femoral circumflex artery and ascending branch of lateral circumflex femoral artery in the bilateral IIA embolization group compared with those in the retained bilateral IIA group after EVAR,P <0.05.There were no significant difference in the inferior mesenteric artery,superficial circumflex artery,and external genital artery of the bilateral IIA embolization group and retained bilateral IIA group after EVAR.P >0.05.4.In the unilateral IIA embolization group,the preoperative vascular diameter changes were statistically significant in the embolism side of the inferior epigastric artery,deep iliac circumflex artery,and medial femoral circumflex artery,and the average blood vessel diameter after and before surgery respectively are 1.87±0.38 mm,1.97±0.43 mm,2.30±0.50 mm and 1.53±0.30 mm,1.53±0.32 mm,1.90±0.48mm;P <0.05;while in the contralateral side,the change was statistically significant in preoperative and postoperative vascular diameter was only inferior epigastric artery,the average blood vessel diameter after and before surgery respectively are 1.92±0.43 mm,1.71±0.28mm;P <0.05.In addition,the preoperative and postoperative blood vessel diameters of the inferior mesenteric artery were also statistically significant(P=0.002),Then compared with the preservation of bilateral inferior IIA group postoperative vessel-inferior mesenteric artery,the difference was not statistically significant,P >0.05.The mean vascular diameter of the embolization side was slightly larger than that of the contralateral side,but the paired t-test showed that only the deep circumflex artery was less than 0.05,which the P value were statistically significant,the average blood vessel diameter of the embolization side and the contralateral side are 1.97±0.43 mm,and 1.49±0.29 mm.The remaining pelvic blood vessel diameters were compared before and after operation,and all of the remaining vessel's paired t test P >0.05,had no statistical significance.Conclusions: 1.After the EVAR embolization IIA,the common pelvic blood supply blood vessels mainly include: inferior mesenteric artery,inferior epigastric artery,deep iliac circumflex artery,superficial iliac circumflex artery,external pudendal artery,medial femoral circumflex artery,ascending branch of lateral circumflex femoral artery.2.The inferior epigastric artery-obturator artery,medial femoral circumflex artery-obturator artery,deep iliac circumflex artery-superior gluteal artery and ascending branch of lateral circumflex femoral artery to the lower part of the gluteus may be potentially important collateral vessels of the pelvic and hip muscle groups after EVAR embolization IIA,which has important compensatory function.3.The preservation of the internal iliac artery by EVAR is an effective method to improve pelvic blood supply and reduce complications of pelvic ischemia.When embolization IIA is unavoidable and preoperative CT assessment of the presence of the inferior epigastric artery,deep iliac circumflex artery,medial femoral circumflex artery,and ascending branch of lateral circumflex femoral artery,it is a relatively safe surgical procedure to embolize internal iliac artery and preserve the distal branch of the internal iliac artery.4.The assessment of pelvic blood vessels by preoperative multi-spiral CTA examination can provide basis and reference for understanding the changes of blood supply in the pelvic region of embolized internal iliac arteries.