Sala Florent, Hassen-Khodja Reda, Branchereau Pascal, Berthet Jean-Philippe, Batt Michel, Mary Henry, Marty-Ane Charles, Alric Pierre
Service de Chirurgie Vasculaire, CHU de Nice, Hôpital Saint Roch, Nice, France.
J Vasc Surg. 2002 Nov;36(5):982-7. doi: 10.1067/mva.2002.128313.
The purpose of this study was determination of the expansion rates relative to the size of the common iliac artery (CIA) after elective placement of a straight aortic tube graft for an infrarenal abdominal aortic aneurysm (AAA).
Between January 1993 and December 1997, 74 men (mean age, 69 years) with AAA underwent surgical repair with a straight tube graft. All patients underwent preoperative and postoperative computed tomography (CT) scans. The mean follow-up period was 68.3 months. The preoperative CT scan revealed a dilatation of at least one of the two CIAs in 32 patients (43.2%; group A). Within this group, the CIA was ectatic (12 mm < diameter < 18 mm) in 13 patients (subgroup A1) and aneurysmal (diameter >/=18 mm) in 19 patients (subgroup A2). The diameters of both CIAs were normal (diameter </=12 mm) in the other 42 patients (56.8%; group B).
Two patients (2.7%) in group A2 needed reoperation because of expansion of the diameter of the CIA; the preoperative diameter of the CIA in both patients was 30 mm. The diameters of the CIA aneurysms in the 17 other patients in subgroup A2 were smaller than 30 mm on the preoperative CT scan. After aortic surgery, the sizes of these aneurysms remained stable the first 5 years and reached a diameter of 30 mm on the CT scans obtained 7 to 8 years after surgery. Overall, 10 of the 74 patients (13.5%) had a CIA aneurysm develop that was smaller than 30 mm in diameter (mean diameter, 19.2 mm) 7 to 8 years after aortic surgery. The presence of a celiac aorta dilatation greater than or equal to 25 mm was the only statistically significant factor predictive of postoperative expansion of a CIA dilatation (P =.03).
Straight aortoaortic tube grafts are indicated for CIAs with diameters smaller than 18 mm. Aorta biiliac bifurcated grafts are justified when the CIA diameter is between 18 and 30 mm, when the patient's life expectancy is longer than 8 years, or when the diameter of the celiac aorta is greater than or equal to 25 mm. A CIA aneurysm greater than or equal to 30 mm should be repaired during the same operative session as the AAA with placement of an aorta biiliac bifurcated graft.
本研究的目的是确定在为肾下腹主动脉瘤（AAA）选择性植入直型主动脉移植管后，相对于髂总动脉（CIA）大小的扩张率。
1993年1月至1997年12月期间，74例男性（平均年龄69岁）AAA患者接受了直型移植管的手术修复。所有患者均接受了术前和术后计算机断层扫描（CT）。平均随访期为68.3个月。术前CT扫描显示32例患者（43.2%；A组）的两条CIA中至少有一条扩张。在该组中，13例患者（A1亚组）的CIA呈扩张状态（直径12mm＜直径＜18mm），19例患者（A2亚组）的CIA呈动脉瘤样（直径≥18mm）。其他42例患者（56.8%；B组）的两条CIA直径均正常（直径≤12mm）。
A2组中有2例患者（2.7%）因CIA直径扩张需要再次手术；这2例患者术前CIA直径均为30mm。A2亚组中其他17例患者的CIA动脉瘤在术前CT扫描时直径小于30mm。主动脉手术后，这些动脉瘤的大小在最初5年保持稳定，在术后7至8年的CT扫描中直径达到30mm。总体而言，74例患者中有10例（13.5%）在主动脉手术后7至8年出现直径小于30mm（平均直径19.2mm）的CIA动脉瘤。腹主动脉扩张≥25mm是唯一具有统计学意义的预测CIA扩张术后扩张的因素（P = 0.03）。
直型主动脉移植管适用于直径小于18mm的CIA。当CIA直径在18至30mm之间、患者预期寿命超过8年或腹主动脉直径≥25mm时，主动脉双髂分叉移植管是合理的选择。直径≥30mm的CIA动脉瘤应在与AAA相同的手术过程中进行修复，并植入主动脉双髂分叉移植管。
