Brau Salvador A, Delamarter Rick B, Schiffman Michael L, Williams Lytton A, Watkins Robert G
Spine Access Surgery Associates, Los Angeles, CA 90024, USA.
Ann Vasc Surg. 2004 Jan;18(1):48-51. doi: 10.1007/s10016-003-0104-0. Epub 2004 Jan 12.
To determine the incidence of left iliac artery thrombosis (LIAT), a prospective database was maintained on 1315 patients undergoing anterior lumbar surgery (ALS) between August 1997 and December 2002. All had distal pulse evaluation preoperatively. In the last 629 cases pulse oxymetry was used to monitor the distal circulation during and after surgery. Patients with pulse deficits or evidence of ischemia after surgery were further analyzed. Six patients were identified with LIAT (0.45%). Five were females and one was male, with ages ranging from 35 to 56 years. All had exposure at the L4-5. Five were diagnosed at surgery and one in the recovery room after posterior surgery. All except one had strong, palpable preoperative pulses. Pulse oxymetry confirmed the diagnosis in two patients, in whom it was not clinically evident. Four had successful thrombectomy; one had a femoro-femoral bypass and one had an axillo-femoral bypass. Two developed compartment syndrome. None had calcifications on preoperative X-rays. LIAT is an uncommon complication of ALS. Early identification and management can avoid long-term complications. Pulse oxymetry helps in its timely identification. Patients undergoing exposure at L4-5 and females are at greater risk.
为确定左髂动脉血栓形成（LIAT）的发生率，我们对1997年8月至2002年12月期间接受前路腰椎手术（ALS）的1315例患者建立了前瞻性数据库。所有患者术前均进行了远端脉搏评估。在最后629例病例中，术中及术后使用脉搏血氧饱和度监测远端循环。对术后出现脉搏缺失或缺血证据的患者进行了进一步分析。共识别出6例LIAT患者（0.45%）。5例为女性，1例为男性，年龄在35至56岁之间。所有患者均在L4 - 5节段进行了手术暴露。5例在手术中诊断，1例在后路手术后在恢复室诊断。除1例患者外，其余患者术前脉搏均可触及且搏动有力。脉搏血氧饱和度在2例临床未发现明显异常的患者中确诊。4例患者成功进行了血栓切除术；1例进行了股-股旁路手术，1例进行了腋-股旁路手术。2例患者出现了骨筋膜室综合征。所有患者术前X线检查均未发现钙化。LIAT是ALS的一种罕见并发症。早期识别和处理可避免长期并发症。脉搏血氧饱和度有助于及时识别。在L4 - 5节段进行手术暴露的患者和女性患者风险更高。
