Timaran C H, Stevens S L, Freeman M B, Goldman M H
Division of Vascular Surgery, Department of Surgery and Graduate School of Medicine, University of Tennessee Medical Center, Knoxville 37920-6999, USA.
J Vasc Surg. 2001 Dec;34(6):971-8. doi: 10.1067/mva.2001.119400.
Iliac artery angioplasty (IAA) is an effective adjunct when combined with infrainguinal arterial reconstructions (IARs) in appropriate patients with multilevel occlusive disease. However, the effect of iliac artery stenting (IAS) on the outcome of patients undergoing distal bypass procedures is not defined. The purpose of this study was to estimate the influence of previous IAS for iliac occlusive disease on the outcome of IARs, compared with those after IAA alone or aortofemoral bypass grafting procedures (AFBs).
During a 5-year period (1995-2000), 105 patients with previous intervention for iliac occlusive disease underwent 120 IARs. The criteria prepared by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery) were followed to define the variables. The TransAtlantic Inter-Society Consensus classification was used to characterize the type of iliac lesions. Univariate (Kaplan-Meier) and multivariate analyses (Cox proportional hazards model) were used to determine the association between preoperative variables and cumulative primary patency.
Forty-five IARs were performed in patients with an earlier IAS repair, 33 in patients with an earlier IAA repair, and 42 in patients with an earlier AFB repair. There were not significant differences between patients in the IAS and IAA groups, except for a more frequent use of polytetrafluoroethylene grafts for IARs in the IAS group (40% vs 15%; chi(2) test, P = .03). The 5-year primary patency rate for IARs was 68% in the IAS group, 46% in the IAA group, and 61% in the AFB group. Univariate analyses revealed that primary patency rates for IARs in patients with previous IAS were significantly higher than those in the IAA group (Kaplan-Meier, log-rank test, P = .02). Previous IAA repair was associated with a two-fold increased risk of IAR graft failure (relative risk, 2.2; 95% CI, 1.1-4.8; P = .04).
IARs in patients with previous IAS have significantly improved graft patency, compared with those in patients with previous IAA alone. Such graft patency for IAR after IAS is similar to that obtained after AFB repair.
对于患有多节段闭塞性疾病的合适患者，髂动脉血管成形术（IAA）与腹股沟下动脉重建术（IAR）联合使用时是一种有效的辅助治疗方法。然而，髂动脉支架置入术（IAS）对接受远端旁路手术患者预后的影响尚不明确。本研究的目的是评估既往因髂动脉闭塞性疾病接受IAS治疗对IAR预后的影响，并与单独接受IAA或主动脉股动脉旁路移植术（AFB）后的患者进行比较。
在5年期间（1995 - 2000年），105例既往因髂动脉闭塞性疾病接受过干预的患者接受了120次IAR。遵循血管外科协会/国际心血管外科学会报告标准特设委员会制定的标准来定义变量。采用跨大西洋跨学会共识分类法来描述髂动脉病变类型。单因素（Kaplan - Meier）和多因素分析（Cox比例风险模型）用于确定术前变量与累积原发性通畅率之间的关联。
45次IAR是在先前接受IAS修复的患者中进行的，33次在先前接受IAA修复的患者中进行，42次在先前接受AFB修复的患者中进行。IAS组和IAA组患者之间没有显著差异，除了IAS组在IAR中更频繁地使用聚四氟乙烯移植物（40%对15%；卡方检验，P = 0.03）。IAS组IAR的5年原发性通畅率为68%，IAA组为46%，AFB组为61%。单因素分析显示，既往接受IAS治疗的患者IAR的原发性通畅率显著高于IAA组（Kaplan - Meier，对数秩检验，P = 0.02）。既往接受IAA修复与IAR移植物失败风险增加两倍相关（相对风险，2.2；95%置信区间，1.1 - 4.8；P = 0.04）。
与仅接受过IAA治疗的患者相比，既往接受IAS治疗的患者进行IAR时移植物通畅率显著提高。IAS后IAR的移植物通畅率与AFB修复后相似。
