Comparative Analysis Of The Clinical Efficacy Of Open Operation And Endovascular Therapy For Isolated Iliac Artery Aneurysm

Objective To do a comparative analysis on the clinical data and therapeutic efficacy of open operation and endovascular therapy for patients with isolated iliac aneurysm.Materials and Methods From January 2010 to August 2018,the information on diagnosis and treatment of patients with IIAA in our hospital(China-Japan Union Hospital of Jilin University)were reviewed.According to the different types of aneurysms and operative plan,the methods of treatment were divided into conservative treatment and operative treatment,and operative treatment was divided in to open operation,interventional operation and hybrid operation.Excluding conservative treatment and hybrid operation,a total of 61 patients(received open operation or endovascular therapy)finally met the criteria for inclusion.18 patients underwent open operation,operation methods mainly included: artificial vascular replacement of aorta abdominalis and bilateral iliac arteries,artificial vascular replacement of common iliac artery and external iliac artery,resection of aneurysm and end-to-end anastomosis of proximal and distal vessels of aneurysms,intracapsular aneurysm repair(Mates operation)and simple ligation of internal iliac artery.43 patients underwent interventional operation,and operation methods included: abdominal aortic bifurcated stent implantation,Iliac artery covered stent implantation,internal iliac artery embolization with coil and internal iliac artery reconstruction.For patients treated with above two methods,mainly analyzed the risk factors(age,gender,smoking history,complications),Clinical symptoms,operative methods,development trend of operative skills,advantages and disadvantages of different operative methods(anesthetic method,Operation time,Blood transfusion volume,transfusion number,duration of monitoring,length of hospitalization,mortality,complication,follow-up)and the treatment of internal iliac artery.At the same time,the diagnosis and treatment experience of IIAA was discussed based on domestic and foreign relevant literatures.Result Patients with IIAA in our hospital is increasing year by year,and the number of patients receiving endoscopic therapy is also increasing.Among 61 patients with IIAA,52 were males and 9 were females,with an average age of 65.39±10.83 years(60.11±10.92 in open operation group and 68.05±10.30 in endoscopic therapy group,P<0.05).There were 89 iliac aneurysms,of which 87 were treated,including 63 common iliac aneurysms,25 internal iliac aneurysms and 1 external iliac aneurysm.The average diameter of aneurysms was 47.02 ±13.74 mm,with 52.56±15.94 mm in open operation group and 44.70±12.17 mm in endoscopic therapy group(P<0.05).There was significant difference between the two groups,which suggested that the diameter of ruptured aneurysms was significantly higher than that of unruptured aneurysms.Operative success rate was 98.4%.The average operation time was158.56±87.82 minutes,with 261.67±67.54 min in the open operation group and 115.40(+52.03)in the endoscopic therapy group(P< 0.01).The average bleeding volume was 332.13±620.99 ml,with 922.22±913.01 ml in the open operation group and85.12±42.34 ml in the endoscopic therapy group(P<0.01).16 patients received intraoperative blood transfusion,12 in the open operation group and 4 in the endoscopic therapy group(P< 0.01).There was no significant difference in average blood transfusion volume between two groups.The average hospitalization time was11.62±4.24 days,14.89± 4.65 days in the open operation group and 10.26±3.24 days in the endoscopic therapy group(P < 0.01).Intraoperative and postoperative complications(delayed healing of incision,gluteal limp,endoleak,subcutaneous hematoma,venous thrombosis,postoperative ileus,anastomotic thrombosis,heart failure,pulmonary embolism)occurred in 13 patients.The incidence of perioperative complications was 21.3%.6 cases(33.3%)in open operation group and 6 cases(14%)in endovenous therapy group(2 cases during operation and 5 cases after operation).There were 4 emergency open operations and 2 cases(50%)died,while 7 emergency operations in endoscopic therapy group and no patients died.The follow-up time was3-24 months,with an average follow-up time of 8.4±5.1 months.One patient died during the follow-up period.There was no significant difference in the incidence of complications(mainly gluteal limp and graft embolism),survival rate and graft patency rate between two groups during the follow-up period.Conclusion 1.?Atherosclerosis is the most important risk factor for IIAA,and aneurysm diameter is positively correlated with the rupture risk of aneurysm;2?Endovascular treatment is more minimally(less)invasive in the case that the curative effect is not worse than that of open surgery;3?Reconstruction of the internal iliac artery is related to the incidence of related complications.