Clinical Efficacy Analysis Of Internal Iliac Artery Reconstruction By Iliac Branched Device

Background : Aneurysm(AA)is a type of vasodilatation caused by degenerative changes in the aorta,resulting in aneurysmal expansion to more than 1.5 times the normal diameter.Iliac artery aneurysm(IAA)includes common,external,and internal iliac aneurysms,depending on the anatomic segment.Iliac aneurysms often coexist with abdominal aortic aneurysm(AAA).With the advancement of medical technology and the aging of our population,the incidence and detection rate of AAA is increasing,and more than 70% of the patients diagnosed with AAA are also combined with IAA,and nearly 30% are also suffering from internal iliac aneurysm.In the past,IAA was mainly treated by open surgery,but the iliac artery was located deep in the pelvis,adjacent to the iliac vein and ureter,which made the surgery difficult and risky,and the internal iliac artery was often directly ligated(internal iliac artery IIA).In recent years,surgeons have continued to recognize the physiological importance of preserving the blood supply to the IIA and that covering the unilateral or bilateral IIA increases the incidence of common complications such as ischemic claudication of the gluteal muscles,impotence,and serious complications such as intestinal ischemia and sacral osteonecrosis.At present,various techniques have been developed internationally to preserve the blood supply to IIA,including traditional open surgery for aneurysm removal and revascularization,hybrid surgery,and common in-wall treatments such as the iliac branched device IBD technique,the bell-bottom technique BBT technique,and the sandwich technique.The IBD technique is an integrated branch stent that conforms to human anatomy and hemodynamics and can effectively preserve the blood supply to the IIA.Objective: To investigate the advantages and disadvantages of different endoluminal techniques in preserving the blood supply to the internal iliac artery,to compare and analyze the clinical efficacy of IBD technique and BBT,and to evaluate the clinical value of IBD technique.Methods:A total of 103 patients treated with endoluminal repair for preserved IIA were retrospectively included from June 2019 to February 2022 in our vascular surgery department for abdominal aortic aneurysm combined with iliac artery aneurysm.The patients were divided into the group with preserved IIA blood supply and the group with bilateral IIA embolization according to the selection of the procedure,in which the group with preserved IIA blood supply included the IBD group and the BBT group.The basic data,surgical procedures,and postoperative observation indexes of all patients were collected,and the main surgeon was the same person in all included cases.One-way analysis of variance,chi-square test and Fisher exact test were also used to statistically analyze the relevant data.Results:All patients were followed up for more than 1 year,with a mean follow-up time of 18.63 months,including 19.60±4.61 months in the IBD group,16.58±3.79 months in the BBT group,and 19.72±4.89 months in the bilateral IIA embolization group.There were no statistically significant differences between the groups in terms of age,preoperative complications such as hypertension,diabetes mellitus,coronary artery disease and other general information(p > 0.05),and the patients in the two groups were comparable.The duration of surgery in the group with preserved IIA blood supply was 148.10±38.64 minutes,which was higher than that in the group with embolized bilateral IIA at 127.63 ± 9.17 minutes,with a p value <0.05,which was statistically significantly different.The incidence of ischemic complications was significantly lower in the group with preserved IIA blood supply than in the group with embolized bilateral IIA,with a p value = 0.043(p < 0.05),a statistically significant difference.the operative time in the IBD group was 208.91±11.42 minutes,significantly higher than that in the BBT group at 125.80±9.89 minutes,with a p value < 0.01,a statistically significant difference.In terms of perioperative creatinine elevation,it was 12.55±2.02 umol/l in the IBD group,which was higher than 10.10±2.16 umol/l in the BBT group,with a p-value < 0.05 and a statistically significant difference.the probability of stent-related complications was significantly lower in the IBD group than in the BBT group,with a p-value = 0.043(p < 0.05)and a statistically significant difference.Conclusion:IBD technology and BBT technology preserve the IIA blood supply,which can effectively reduce the probability of ischemic complications in the gluteal muscle compared with conventional EVAR embolization of bilateral IIA.IBD is significantly lower than BBT technology in terms of the incidence of stent endoleaks,and IBD technology uses integrated branch stents,which conform to human anatomy and hemodynamics,with high technical success rate,high patency rate,stent-related complications and clinical The incidence of stent-related complications and clinical complications is low.It is safe and effective,and is theoretically the most ideal endoluminal treatment for reconstruction of IIA.