Lee W Anthony, Berceli Scott A, Huber Thomas S, Ozaki C Keith, Flynn Timothy C, Seeger James M
Division of Vascular and Endovascular Therapy, University of Florida College of Medicine, Gainsville, Fl, USA.
J Vasc Surg. 2003 Sep;38(3):459-63; discussion 464-5. doi: 10.1016/s0741-5214(03)00726-2.
Retroperitoneal iliac procedures can enable successful endovascular repair of abdominal aortic aneurysm (AAA) in patients who otherwise would not be anatomically eligible. The purpose of this study was to determine perioperative outcome with adjunctive retroperitoneal procedures compared with standard bilateral femoral exposure.
Between August 1997 and November 2002, 164 patients underwent elective endovascular AAA repair at a single university medical center. Anatomic, demographic, and early postoperative outcome data gathered prospectively were analyzed. Thirty-two patients (20%) underwent 38 separate adjunctive retroperitoneal procedures. Indications included small external iliac arteries (16 of 32 patients; 50%) and concomitant iliac aneurysm that precluded fixation of the endograft limbs in the common iliac arteries (16 of 32 patients; 50%). The 38 procedures consisted of 8 iliac conduits only, 14 iliac conduits with iliofemoral bypass grafts, and 16 hypogastric revascularization procedures. Data for the study patients were compared with data for 132 patients who underwent endovascular AAA repair through femoral incisions. Primary end points were hospital length of stay, and early morbidity and mortality.
Retroperitoneal procedures enabled an additional 14% of patients with AAA to undergo endovascular techniques. However, there was a significantly higher proportion of women and patients at high risk for anesthesia (American Society of Anesthesiologists class IV or higher) in the group who underwent retroperitoneal procedures. On average, retroperitoneal procedures were associated with 2.6-fold greater blood loss, 82% longer procedure time, 1.5 days additional hospital stay, and 1.8-fold higher rate of perioperative complications, compared with endovascular AAA repair with femoral exposure alone. In contrast, early mortality was similar in the two groups.
Adjunctive retroperitoneal procedures during endovascular AAA repair are associated with increased risk for complications and longer hospital length of stay, compared with AAA repair with standard femoral exposure only. They do not, however, increase early mortality, even in patients at high risk, and enable a larger subset of patients with AAA to undergo endovascular repair.
对于那些解剖结构上不适合的患者，腹膜后髂血管手术可使腹主动脉瘤（AAA）的血管内修复成功进行。本研究的目的是确定与标准双侧股部暴露相比，辅助性腹膜后手术的围手术期结果。
1997年8月至2002年11月期间，164例患者在单一大学医学中心接受了择期血管内AAA修复术。对前瞻性收集的解剖学、人口统计学和术后早期结果数据进行分析。32例患者（20%）接受了38次单独的辅助性腹膜后手术。适应症包括小的髂外动脉（32例患者中的16例；50%）和伴有髂动脉瘤，这使得不能将血管内移植物肢体固定于髂总动脉（32例患者中的16例；50%）。38例手术包括仅8例髂血管导管植入术、14例带髂股旁路移植术的髂血管导管植入术和16例下腹血管重建术。将研究患者的数据与132例通过股部切口进行血管内AAA修复的患者的数据进行比较。主要终点是住院时间以及早期发病率和死亡率。
腹膜后手术使另外14%的AAA患者能够接受血管内技术。然而，接受腹膜后手术的患者组中女性比例和麻醉高风险患者（美国麻醉医师协会IV级或更高级别）比例明显更高。平均而言，与仅通过股部暴露进行血管内AAA修复相比，腹膜后手术的失血量增加2.6倍，手术时间延长82%，住院时间增加1.5天，围手术期并发症发生率高1.8倍。相比之下，两组的早期死亡率相似。
与仅采用标准股部暴露的AAA修复相比，血管内AAA修复期间的辅助性腹膜后手术与并发症风险增加和住院时间延长相关。然而，即使在高风险患者中，它们也不会增加早期死亡率，并使更多的AAA患者能够接受血管内修复。
