血管内移植物在复杂性主-髂动脉闭塞性疾病中的新作用。

Emerging role of endovascular grafts in complex aortoiliac occlusive disease.

作者信息

Ali Ahsan T, Modrall J Gregory, Lopez Jorge, Brawley John G, Welborn M Burress, Clagett G Patrick, Valentine R James, Jackson Mark R

机构信息

Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

出版信息

J Vasc Surg. 2003 Sep;38(3):486-91. doi: 10.1016/s0741-5214(03)00886-3.

DOI:10.1016/s0741-5214(03)00886-3

PMID:12947263

Abstract

BACKGROUND

Aortobifemoral bypass is the standard therapy for complex aortoiliac occlusive disease. The purpose of this study was to examine the use of endovascular grafts as an alternative to aortobifemoral bypass in patients with advanced aortoiliac occlusive disease at high risk.

METHODS

Endovascular grafts were placed in 23 limbs in 22 patients with TransAtlantic Inter-Society Consensus document (TASC) type C and D lesions. All procedures were performed in the operating room, and images were obtained with portable digital fluoroscopy. Surgical exposure of the ipsilateral common femoral artery was performed to enable safe closure of 9F to 12F sheath sites and to facilitate ipsilateral interventions in the distal external iliac artery. Concomitant infrainguinal outflow procedures were performed in 6 patients.

RESULTS

Twenty of 22 patients were men; mean patient age was 63.2 +/- 3.2 years. Indications for intervention were rest pain in 12 of 23 limbs and tissue loss in 9 of 22 limbs. Risk factors included hostile abdomen or pelvis in 8 patients, coronary artery disease in 11 patients, end-stage renal disease in 3 patients, and severe chronic obstructive pulmonary disease in 3 patients. Each patient received a mean of 1.6 grafts. Initial technical success was 95.2%, with one technical failure. There was no 30-day mortality. All patients experienced at least one grade improvement per Society for Vascular Surgery reporting standards. Primary patency at 24 months was 84.2% +/- 8.0%, with a limb salvage rate of 95.3% +/- 5.0%. Mean (+/- SD) ankle brachial index improved from 0.49 +/- 0.22 to 0.87 +/- 0.26 (P <.001).

CONCLUSION

Endovascular grafting to treat advanced aortoiliac occlusive disease can be accomplished with good clinical outcome and acceptable short-term patency. This endovascular technique can be a viable alternative to conventional surgical revascularization in patients with advanced aortoiliac occlusive disease at high risk.

摘要

背景

主-双股动脉旁路移植术是治疗复杂性主-髂动脉闭塞性疾病的标准疗法。本研究的目的是探讨对于患有晚期主-髂动脉闭塞性疾病且高危的患者，使用血管腔内移植物作为主-双股动脉旁路移植术替代方案的情况。

方法

为22例患有跨大西洋跨协会共识文件（TASC）C型和D型病变的患者的23条肢体植入血管腔内移植物。所有手术均在手术室进行，通过便携式数字荧光透视获得图像。对同侧股总动脉进行手术暴露，以确保安全闭合9F至12F鞘管部位，并便于对同侧髂外动脉远端进行干预。6例患者同时进行了腹股沟下流出道手术。

结果

22例患者中有20例为男性；患者平均年龄为63.2±3.2岁。干预指征为23条肢体中有12条出现静息痛，22条肢体中有9条出现组织缺损。危险因素包括8例患者存在难治性腹部或骨盆情况、11例患者患有冠状动脉疾病、3例患者患有终末期肾病以及3例患者患有严重慢性阻塞性肺疾病。每位患者平均植入1.6个移植物。初始技术成功率为95.2%，有1例技术失败。无30天死亡率。按照血管外科学会报告标准，所有患者均至少有1级改善。24个月时的原发性通畅率为84.2%±8.0%，肢体挽救率为95.3%±5.0%。平均（±标准差）踝肱指数从0.49±0.22提高到0.87±0.26（P<.001）。