| Background&Objectives:Abdominal aortic aneurysm[1]refers to the small peripheral dilatation of the wall of the abdominal aorta,which reaches 50%of the normal diameter of the abdominal aorta;when the tumor is premonitory rupture or rupture,the mortality rate can reach 50%.80%,Patients with unilateral or bilateral iliac aneurysms account for about 40%of patients with abdominal aortic aneurysms[2,3],and 10-30%of cases involve the internal iliac artery.Abdominal aortic aneurysms with distal malanatomy such as internal iliac aneurysms pose a challenge to endovascular repair[4]:displacement caused by unstable distal Anchorage of stents;distal type I internal leakage;type Ⅱinternal leakage caused by unblocked internal iliac artery blood reflux.Part of the operation is to place a varying number of coils in the internal iliac artery to embolize the internal iliac artery,which solves the internal leakage to a large extent,and the treatment of the internal iliac artery can lead to serious complications,such as gluteal claudication and erectile dysfunction.In rare cases,it can also lead to life-threatening complications:colonic ischemia,perineal necrosis,pressure sores nonunion,sensory abnormalities of lower extremities,urinary incontinence and acute limb ischemia[5].In this research center,the covered stent was used to directly block the opening of the internal iliac artery to deal with the malanatomy of the distal part of the abdominal aortic aneurysm,and to explore the study of the complications of pelvic ischemia.Methods:A retrospective analysis was made of 50 patients with abdominal aortic aneurysm in the Department of Vascular surgery of the third affiliated Hospital of Guangzhou Medical University from April 2013 to July 2019.4(8%)of the patients lost follow-up due to various reasons,and 46 patients were followed up continuously.Among them,8 cases were diagnosed as ruptured or premonitory ruptured abdominal aortic aneurysm,and all of these patients underwent minimally invasive treatment of endovascular repair of abdominal aortic aneurysm.According to whether the iliac branch of the stent covered the opening of the internal iliac artery,the patients in the unilateral internal iliac artery group were divided into group A(n=25).The patients who covered the bilateral internal iliac arteries were divided into group B(n=9)and the patients without bilateral internal iliac arteries(n=12)were divided into group C(n=12).After operation,these patients were followed up regularly by professional doctors in the department,and the occurrence of complications of pelvic ischemia was counted.Combined with SPSS25.0 statistical software,the corresponding statistical methods were used to analyze the clinical data and inervention factors,and to analyze the influence of operation methods and clinical general data on postoperative pelvic ischemia complications.Results:There was no significant difference in age,sex,maximum transverse diameter of abdominal aortic aneurysm,number of internal iliac aneurysm and chronic diseases such as hypertension,diabetes,coronary heart disease and COPD among the three groups(p=0.922,0.184,0.459,0.207,0.796,0.508,0.350,0.530,respectively).There were significant differences in the maximum transverse diameter and length of common iliac artery.During the operation,46 cases were performed successfully(100%).At the end of the operation,angiographic examination was performed at the end of the operation.In group B,there was a slight type Ⅱ internal leakage in 1 case,mainly for observation and without special treatment.No type I internal leakage occurred.There was no significant difference in operation time and follow-up time after discharge among the three groups(p=0.384 and 0.333,respectively).The results showed that the difference of covering the opening of internal iliac artery in group A,B and C had statistical difference in the occurrence of pelvic ischemic complications(p=0.001).There were significant differences in these pelvic complications such as gluteal muscle claudication and sexual dysfunction(p=0.035 and 0.035 respectively),but there was no significant difference in sacral pain and discomfort(p=0.763).In this paper,the patients’ preoperative age,sex,and basic diseases such as diabetes,hypertension,emphysema and coronary heart disease were studied.The comprehensive analysis of whether the internal iliac artery was covered during the operation and the risk factors of postoperative pelvic ischemia complications were analyzed by multivariate binary logistic regression analysis.The results showed that only the intervention factor of stent covering the bilateral internal iliac artery openings was the risk factor for the occurrence of postoperative pelvic ischemia(Preservation 0.049 OR 47.52395%CI 1.01722220.264).Follow-up time,coronary heart disease,COPD,male patients were negatively correlated with these complications,but there was no significant statistical significance.Conclusion:1.Endovascular repair is a good choice for the treatment of abdominal aortic aneurysm,2.When abdominal aortic aneurysm is associated with common iliac aneurysm,internal iliac aneurysm and poor anatomical structure of the opening of internal iliac artery,there are no serious pelvic complications such as colonic necrosis and perineal necrosis when stents are used to cover the opening of internal iliac artery directly.3.The probability of pelvic complications such as gluteal claudication and sexual dysfunction after bilateral internal iliac artery occlusion is higher than that of unilateral internal iliac artery occlusion and non-occlusion of internal iliac artery. |
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