O'Connor S E, Walsh D B, Zwolak R M, Schneider J R, Cronenwett J L
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756.
Ann Vasc Surg. 1992 Nov;6(6):493-8. doi: 10.1007/BF02000819.
Nine patients with end-to-side aortobifemoral bypasses were studied in the first year after surgery using color duplex imaging to determine the source of pelvic blood flow. No patient had clinical evidence of postoperative pelvic ischemia. Six of nine patients were found to have occluded distal aortas by duplex studies performed at a mean of 4.4 months postoperatively (range 0.8-8.2 months). Of those six patients, postoperative duplex examination demonstrated two with no common or external iliac blood flow, two with bilateral retrograde external iliac flow, and two with unilateral retrograde external iliac flow. Of the three patients with patent distal aortas, two had no demonstrable external iliac blood flow, while the third had continued antegrade flow through one external iliac and retrograde flow through the other. Analysis of preoperative arteriograms failed to reveal accurate predictors of postoperative distal aortic patency or retrograde iliac blood flow. Despite the preoperative assumption that prograde common iliac artery blood was required to prevent pelvic ischemia, distal aortic patency was maintained in only three of nine patients. In the six patients with prograde iliac blood flow, no ischemic symptoms were present, including two patients with complete absence of antegrade aortic or retrograde external iliac blood flow. Our observations indicate that assumptions which underlie the decision to perform end-to-side aortic anastomoses are often not borne out in the months following aortobifemoral bypass.
在术后第一年，对9例行端侧主动脉双股动脉搭桥术的患者进行了研究，采用彩色双功超声成像来确定盆腔血流的来源。没有患者有术后盆腔缺血的临床证据。通过术后平均4.4个月（范围0.8 - 8.2个月）进行的双功超声研究发现，9例患者中有6例远端主动脉闭塞。在这6例患者中，术后双功超声检查显示，2例没有股总动脉或髂外动脉血流，2例有双侧髂外动脉逆行血流，2例有单侧髂外动脉逆行血流。在3例远端主动脉通畅的患者中，2例没有可显示的髂外动脉血流，而第3例有一条髂外动脉持续顺行血流，另一条髂外动脉逆行血流。术前动脉造影分析未能揭示术后远端主动脉通畅或髂外动脉逆行血流的准确预测指标。尽管术前认为需要髂总动脉顺行血流来预防盆腔缺血，但9例患者中只有3例维持了远端主动脉通畅。在6例有髂动脉顺行血流的患者中，没有出现缺血症状，包括2例完全没有主动脉顺行血流或髂外动脉逆行血流的患者。我们的观察表明，在主动脉双股动脉搭桥术后数月，做出端侧主动脉吻合决定所依据的假设往往得不到证实。
