内腸骨動脈塞栓術直後に生じた重症殿筋虚血

腹部大動脈ステントグラフト内挿術(EVAR)時に腸骨動脈瘤を合併する場合,術後のType II endoleakを予防するため一般に塞栓術が施行されるが,その合併症として術後骨盤内虚血がある.症例は82歳男性.腹部大動脈瘤,両側総腸骨動脈瘤に対して右内腸骨動脈コイル塞栓術後を,その1週間後に二期的にEVARおよび左内腸骨動脈コイル塞栓術を施行した.術直後から左臀部の高度安静時疼痛および左臀部チアノーゼを発症し,重症殿筋虚血の診断で緊急左外腸骨動脈–内腸骨動脈バイパス術を施行した.術後チアノーゼおよび安静時疼痛は消失し,術後造影CTにてendoleakなく,バイパスは良好に開存していた.EVAR...

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Published in日本血管外科学会雑誌 Vol. 29; no. 2; pp. 137 - 140
Main Authors 古田, 晃久, 向井, 省吾, 北浦, 順也, 二神, 大介, 森元, 博信
Format Journal Article
LanguageJapanese
Published 特定非営利活動法人 日本血管外科学会 23.04.2020
日本血管外科学会
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ISSN0918-6778
1881-767X
DOI10.11401/jsvs.20-00005

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Abstract 腹部大動脈ステントグラフト内挿術(EVAR)時に腸骨動脈瘤を合併する場合,術後のType II endoleakを予防するため一般に塞栓術が施行されるが,その合併症として術後骨盤内虚血がある.症例は82歳男性.腹部大動脈瘤,両側総腸骨動脈瘤に対して右内腸骨動脈コイル塞栓術後を,その1週間後に二期的にEVARおよび左内腸骨動脈コイル塞栓術を施行した.術直後から左臀部の高度安静時疼痛および左臀部チアノーゼを発症し,重症殿筋虚血の診断で緊急左外腸骨動脈–内腸骨動脈バイパス術を施行した.術後チアノーゼおよび安静時疼痛は消失し,術後造影CTにてendoleakなく,バイパスは良好に開存していた.EVARに併施した内腸骨動脈塞栓術直後に重症殿筋虚血を呈した場合,速やかな腸骨動脈血行再建が必要である.
AbstractList 「要旨」: 腹部大動脈ステントグラフト内挿術(EVAR)時に腸骨動脈瘤を合併する場合, 術後のType II endoleakを予防するため一般に塞栓術が施行されるが, その合併症として術後骨盤内虚血がある. 症例は82歳男性. 腹部大動脈瘤, 両側総腸骨動脈瘤に対して右内腸骨動脈コイル塞栓術後を, その1週間後に二期的にEVARおよび左内腸骨動脈コイル塞栓術を施行した. 術直後から左臀部の高度安静時疼痛および左臀部チアノーゼを発症し, 重症殿筋虚血の診断で緊急左外腸骨動脈-内腸骨動脈バイパス術を施行した. 術後チアノーゼおよび安静時疼痛は消失し, 術後造影CTにてendoleakなく, バイパスは良好に開存していた. EVARに併施した内腸骨動脈塞栓術直後に重症殿筋虚血を呈した場合, 速やかな腸骨動脈血行再建が必要である.
腹部大動脈ステントグラフト内挿術(EVAR)時に腸骨動脈瘤を合併する場合,術後のType II endoleakを予防するため一般に塞栓術が施行されるが,その合併症として術後骨盤内虚血がある.症例は82歳男性.腹部大動脈瘤,両側総腸骨動脈瘤に対して右内腸骨動脈コイル塞栓術後を,その1週間後に二期的にEVARおよび左内腸骨動脈コイル塞栓術を施行した.術直後から左臀部の高度安静時疼痛および左臀部チアノーゼを発症し,重症殿筋虚血の診断で緊急左外腸骨動脈–内腸骨動脈バイパス術を施行した.術後チアノーゼおよび安静時疼痛は消失し,術後造影CTにてendoleakなく,バイパスは良好に開存していた.EVARに併施した内腸骨動脈塞栓術直後に重症殿筋虚血を呈した場合,速やかな腸骨動脈血行再建が必要である.
Author 森元, 博信
古田, 晃久
向井, 省吾
二神, 大介
北浦, 順也
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References 14) Yano OJ, Morrissey N, Eisen L, et al. Intentional internal iliac artery occlusion to facilitate endovascular repair of aortoiliac aneurysms. J Vasc Surg 2001; 34: 204–211.
8)高松昌史,吉田博希,稲葉雅史.外腸骨–内腸骨動脈バイパス併置ステントグラフト内挿術を行った腹部腸骨動脈瘤の1例.日血外会誌2015; 24: 786–789.
17) Iliopoulos JI, Hermreck AS, Thomas JH, et al. Hemodynamics of the hypogastric arterial circulation. J Vasc Surg 1989; 9: 637–642.
4) Hobo R, Sybrandy JE, Harris PL, et al.; EUROSTAR Collaborators. Endovascular repair of abdominal aortic aneurysms with concomitant common iliac artery aneurysm: outcome analysis of the EUROSTAR experience. J Endovasc Ther 2008; 15: 12–22.
9) Chun JY, Mailli L, Abbasi MA, et al. Embolization of the internal iliac artery before EVAR: is it effective? Is it safe? Which technique should be used? Cardiovasc Intervent Radiol 2014; 37: 329–336.
18) Sugano N, Inoue Y, Iwai T. Evaluation of buttock claudication with hypogastric artery stump pressure measurement and near infrared spectroscopy after abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2003; 26: 45–51.
3) Hinchliffe RJ, Alric P, Rose D, et al. Comparison of morphologic features of intact and ruptured aneurysms of infrarenal abdominal aorta. J Vasc Surg 2003; 38: 88–92.
1) Rayt HS, Bown MJ, Lambert KV, et al. Buttock claudication and erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair. Cardiovasc Intervent Radiol 2008; 31: 728–734.
19)相馬祐介,舘林孝幸,野地 智.内腸骨動脈コイル塞栓術で広範囲殿筋壊死を生じたEVARの1例.日血外会誌2016; 25: 347–351.
2) Bosanquet DC, Wilcox C, Whitehurst L, et al.; British Society of Endovascular therapy (BSET). Systematic review and meta-analysis of the effect of internal iliac artery exclusion for patients undergoing EVAR. Eur J Vasc Endovasc Surg 2017; 53: 534–548.
12) Engelke C, Elford J, Morgan RA, et al. Internal iliac artery embolization with bilateral occlusion before endovascular aortoiliac aneurysm repair-clinical outcome of simultaneous and sequential intervention. J Vasc Interv Radiol 2002; 13: 667–676.
16)佐藤博子,佐藤 成,渡辺徹雄,他.近赤外線分光法による腹部大動脈瘤手術時の骨盤内側副血行評価.日血外会誌2006; 15: 541–550.
15) Fujioka S, Hosaka S, Morimura H, et al. Outcomes of extended endovascular aortic repair for aorto-iliac aneurysm with internal iliac artery occlusion. Ann Vasc Dis 2017; 10: 359–363.
6) Mansukhani NA, Havelka GE, Helenowski IB, et al. Hybrid endovascular aortic aneurysm repair: preservation of pelvic perfusion with external to internal iliac artery bypass. Ann Vasc Surg 2017; 42: 162–168.
10) Maldonado TS, Ranson M, Rockman CB, et al. Decreased ischemic complications after endovascular aortic aneurysm repair with newer devices. Vasc Endovascular Surg 2007; 41: 192–199.
20) Unno N, Inuzuka K, Yamamoto N, et al. Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. J Vasc Surg 2006; 44: 1170–1175.
13) McGarry JG, Alenezi AO, McGrath FP, et al. How safe is internal iliac artery embolisation prior to EVAR? A 10-year retrospective review. Ir J Med Sci 2016; 185: 865–869.
5) Schneider DB, Matsumura JS, Lee JT, et al. Prospective, multicenter study of endovascular repair of aortoiliac and iliac aneurysms using the Gore Iliac Branch Endoprosthesis. J Vasc Surg 2017; 66: 775–785.
7) Faries PL, Morrissey N, Burks JA, et al. Internal iliac artery revascularization as an adjunct to endovascular repair of aortoiliac aneurysms. J Vasc Surg 2001; 34: 892–899.
11) Bratby MJ, Munneke GM, Belli AM, et al. How safe is bilateral internal iliac artery embolization prior to EVAR? Cardiovasc Intervent Radiol 2008; 31: 246–253.
References_xml – reference: 3) Hinchliffe RJ, Alric P, Rose D, et al. Comparison of morphologic features of intact and ruptured aneurysms of infrarenal abdominal aorta. J Vasc Surg 2003; 38: 88–92.
– reference: 2) Bosanquet DC, Wilcox C, Whitehurst L, et al.; British Society of Endovascular therapy (BSET). Systematic review and meta-analysis of the effect of internal iliac artery exclusion for patients undergoing EVAR. Eur J Vasc Endovasc Surg 2017; 53: 534–548.
– reference: 14) Yano OJ, Morrissey N, Eisen L, et al. Intentional internal iliac artery occlusion to facilitate endovascular repair of aortoiliac aneurysms. J Vasc Surg 2001; 34: 204–211.
– reference: 8)高松昌史,吉田博希,稲葉雅史.外腸骨–内腸骨動脈バイパス併置ステントグラフト内挿術を行った腹部腸骨動脈瘤の1例.日血外会誌2015; 24: 786–789.
– reference: 16)佐藤博子,佐藤 成,渡辺徹雄,他.近赤外線分光法による腹部大動脈瘤手術時の骨盤内側副血行評価.日血外会誌2006; 15: 541–550.
– reference: 1) Rayt HS, Bown MJ, Lambert KV, et al. Buttock claudication and erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair. Cardiovasc Intervent Radiol 2008; 31: 728–734.
– reference: 7) Faries PL, Morrissey N, Burks JA, et al. Internal iliac artery revascularization as an adjunct to endovascular repair of aortoiliac aneurysms. J Vasc Surg 2001; 34: 892–899.
– reference: 17) Iliopoulos JI, Hermreck AS, Thomas JH, et al. Hemodynamics of the hypogastric arterial circulation. J Vasc Surg 1989; 9: 637–642.
– reference: 18) Sugano N, Inoue Y, Iwai T. Evaluation of buttock claudication with hypogastric artery stump pressure measurement and near infrared spectroscopy after abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2003; 26: 45–51.
– reference: 10) Maldonado TS, Ranson M, Rockman CB, et al. Decreased ischemic complications after endovascular aortic aneurysm repair with newer devices. Vasc Endovascular Surg 2007; 41: 192–199.
– reference: 11) Bratby MJ, Munneke GM, Belli AM, et al. How safe is bilateral internal iliac artery embolization prior to EVAR? Cardiovasc Intervent Radiol 2008; 31: 246–253.
– reference: 9) Chun JY, Mailli L, Abbasi MA, et al. Embolization of the internal iliac artery before EVAR: is it effective? Is it safe? Which technique should be used? Cardiovasc Intervent Radiol 2014; 37: 329–336.
– reference: 5) Schneider DB, Matsumura JS, Lee JT, et al. Prospective, multicenter study of endovascular repair of aortoiliac and iliac aneurysms using the Gore Iliac Branch Endoprosthesis. J Vasc Surg 2017; 66: 775–785.
– reference: 13) McGarry JG, Alenezi AO, McGrath FP, et al. How safe is internal iliac artery embolisation prior to EVAR? A 10-year retrospective review. Ir J Med Sci 2016; 185: 865–869.
– reference: 20) Unno N, Inuzuka K, Yamamoto N, et al. Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. J Vasc Surg 2006; 44: 1170–1175.
– reference: 6) Mansukhani NA, Havelka GE, Helenowski IB, et al. Hybrid endovascular aortic aneurysm repair: preservation of pelvic perfusion with external to internal iliac artery bypass. Ann Vasc Surg 2017; 42: 162–168.
– reference: 4) Hobo R, Sybrandy JE, Harris PL, et al.; EUROSTAR Collaborators. Endovascular repair of abdominal aortic aneurysms with concomitant common iliac artery aneurysm: outcome analysis of the EUROSTAR experience. J Endovasc Ther 2008; 15: 12–22.
– reference: 12) Engelke C, Elford J, Morgan RA, et al. Internal iliac artery embolization with bilateral occlusion before endovascular aortoiliac aneurysm repair-clinical outcome of simultaneous and sequential intervention. J Vasc Interv Radiol 2002; 13: 667–676.
– reference: 15) Fujioka S, Hosaka S, Morimura H, et al. Outcomes of extended endovascular aortic repair for aorto-iliac aneurysm with internal iliac artery occlusion. Ann Vasc Dis 2017; 10: 359–363.
– reference: 19)相馬祐介,舘林孝幸,野地 智.内腸骨動脈コイル塞栓術で広範囲殿筋壊死を生じたEVARの1例.日血外会誌2016; 25: 347–351.
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Snippet 腹部大動脈ステントグラフト内挿術(EVAR)時に腸骨動脈瘤を合併する場合,術後のType II endoleakを予防するため一般に塞栓術が施行されるが,その合併症として術後骨盤...
「要旨」: 腹部大動脈ステントグラフト内挿術(EVAR)時に腸骨動脈瘤を合併する場合, 術後のType II endoleakを予防するため一般に塞栓術が施行されるが, その合併症として術...
SourceID medicalonline
jstage
SourceType Publisher
StartPage 137
SubjectTerms コイル塞栓術
ステントグラフト
殿筋虚血
腸骨動脈血行再建
Title 内腸骨動脈塞栓術直後に生じた重症殿筋虚血
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