대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제63권2호
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  • Pages.123-130
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  • 2010
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  • 1738-2637(pISSN)
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  • 2951-0805(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

단독 엉덩동맥류의 혈관 내 치료: 후향적 분석

Endovascular Management of Isolated Iliac Artery Aneurysms: Retrospective Analysis

  • 홍준형 (전남대학교 의과대학 영상의학교실) ;
  • 정민영 (전남대학교 의과대학 영상의학교실) ;
  • 김형준 (전남대학교 의과대학 영상의학교실) ;
  • 장남규 (전남대학교 의과대학 영상의학교실) ;
  • 김재규 (전남대학교 의과대학 영상의학교실) ;
  • 최수진나 (전남대학교 의과대학 외과학교실) ;
  • 정상영 (전남대학교 의과대학 외과학교실)
  • Hong, Jun-Hyung (Department of Radiology, Chonnam National University Medical School) ;
  • Jung, Min-Young (Department of Radiology, Chonnam National University Medical School) ;
  • Kim, Hyung-Jun (Department of Radiology, Chonnam National University Medical School) ;
  • Jang, Nam-Kyu (Department of Radiology, Chonnam National University Medical School) ;
  • Kim, Jae-Kyu (Department of Radiology, Chonnam National University Medical School) ;
  • Choi, Soo-Jin-Na (Department of Surtery, Chonnam National University Medical School) ;
  • Chung, Sang-Young (Department of Surtery, Chonnam National University Medical School)
  • 투고 : 2010.02.25
  • 심사 : 2010.06.20
  • 발행 : 2010.08.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 단독 엉덩동맥류에 대해 혈관 내 치료를 받은 환자들의 단기 및 중기 결과 및 예후를 평가하고자 한다. 대상과 방법: 2004년 2월부터 2009년 4월까지 단독 엉덩동맥류로 진단받고 인조혈관 스텐트 치료나 색전술 등 혈관 내 치료를 받은 환자 중 15명(남자: 여자=9:6, 평균 연령 68.1세, 범위 44-79세)을 대상으로 하였다. 이들은 진단 목적 및 치료 후 추적 검사로 computed tomography angiography (CTA)를 시행하였다. 환자들의 의료 기록 및 영상을 후향적으로 분석하여, 시술 전후 증상, 동반 질환 유무, 동맥류의 해부학적 평가 및 합병증 유무를 확인하였다. 기술적 성공은 내강누출 없이 시술을 마치는 경우로 하였고, 임상적 성공 기준은 추적 관찰 시 증상의 개선, 스텐트 개통률 및 엉덩동맥류 크기의 증가가 없는 경우로 하였다. 결과: 동맥류 직경은 20 mm에서 80 mm 사이였다(평균 36.9 mm). 동맥류의 위치는 온엉덩 동맥 8명, 속엉덩동맥 5명, 그리고 온엉덩동맥과 속엉덩동맥에 함께 존재하는 경우가 2명이었다. 모든 환자에서 스텐트가 사용되었으며, 종류는 관형 인조혈관 스텐트가 12명, 대동맥-엉덩동맥 인조혈관 스텐트가 3명이었다. 색전술을 시행한 속엉덩동맥은 11명(미세코일 6명, Amplatz vascular plug 7명, 둘 다 이용한 경우 2명)이었다. 시술 후 넙다리동맥 사이 우회술을 시행한 1명을 제외한 14명에서 혈관 내 치료에 성공하였다. 추적 관찰 기간은 7일에서 701일(평균 125.5일)이었으며, 모든 환자에서 좋은 스텐트 개통률을 보여주었다. 추적 CTA에서 1형 내강누출(endoleak)이 1명, 2형 내강누출이 1명 관찰되었다. 결론: 단독 엉덩동맥류의 혈관 내 치료는 안전하고 최소 침습적인 치료법으로, 좋은 단기 및 중기 결과와 낮은 합병증 발병률을 보여주었다.

Purpose: To evaluate the early and midterm results of the endovascular treatment of patients that had an isolated iliac artery aneurysm (IIAA). Materials and Methods: From February 2004 to April 2009, 15 patients (9 men, 6 women) with IIAA underwent endovascular treatment such as stent graft insertion or embolization. Computed tomography angiography (CTA) was performed for the diagnosis of an aneurysm and for a follow-up after treatment. The medial records and CTAs were retrospectively reviewed for analysis of the symptoms, past history of disease, combined disease, anatomical morphology of aneurysm, and complications. Results: The mean aneurysm diameter was 36.9 mm (range: 20 mm - 80 mm). The aneurysm sites included the common iliac in 8 patients, internal iliac in 5 patients, and a combined common and internal iliac in 2 patients. Tubular stent grafts or bifurcated aorto-iliac stent grafts were used singly or mixed. The internal iliac arteries of 11 patients were embolized by microcoils or by Amplatz vascular plugs or by both methods. The technical success achieved for embolization was 93.3% (n=14). The mean follow-up period was 125.5 days (range: 7 - 701 days). The stent graft patency rate was 100%. On follow- up CTA, 1 patient experienced a type I endoleak, whereas 1 patient experienced a type II endoleak. Conclusion: The endovascular treatment of IIAA shows positive early and mid-term results. The procedure is a safe, minimally invasive, and has a low complication rate.

키워드

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