Arko Frank R, Lee W Anthony, Hill Bradley B, Fogarty Thomas J, Zarins Christopher K
Division of Vascular Surgery, Stanford University Medical Center, Stanford University, Stanford, CA 94305, USA.
J Vasc Surg. 2004 Feb;39(2):404-8. doi: 10.1016/j.jvs.2003.07.012.
This study was carried out to compare the functional outcomes after hypogastric artery bypass and coil embolization for management of common iliac artery aneurysms in the endovascular repair of aortoiliac aneurysms (EVAR).
Between 1996 and 2002, 265 patients underwent elective or emergent EVAR. Data were retrospectively reviewed for 21 (8%) patients with iliac artery aneurysms 25 mm or larger that involved the iliac bifurcation. Patients underwent hypogastric artery bypass (n = 9) or coil embolization (n = 12). Interviews about past and current levels of activity were conducted. A disability score (DS) was quantitatively graded on a discrete scale ranging from 0 to 10, corresponding to "virtually bed-bound" to exercise tolerance "greater than a mile." Worsening or improvement of symptoms was expressed as a difference in DS between two time points (-, worsening; +, improvement).
There was no difference in age (72.6 +/- 7.3 years vs 73.1 +/- 6.4 years), sex (male-female ratio, 8:1 vs 11:1), abdominal aortic aneurysm size (60.1 +/- 5.9 mm vs 59.3 +/- 7.0 mm), or number of preoperative comorbid conditions (1.9 +/- 0.8 vs 2.1 +/- 0.8) between hypogastric bypass and coil embolization groups, respectively. Mean follow-up was shorter after hypogastric bypass (14.8 vs 20.5 months; P <.05). There was no difference in the mean overall baseline DS between the bypass and the embolization groups (8.0 vs 7.8). Six (50%) of the 12 patients with coil embolization reported symptoms of buttock claudication ipsilateral to the occluded hypogastric artery. No symptoms of buttock claudication were reported after hypogastric bypass (P <.05). There was a decrease in the DS after both procedures; however, coil embolization was associated with a significantly worse DS compared with hypogastric artery bypass (4.5 vs 7.3; P <.001). In 4 (67%) of 6 patients with claudication after coil embolization symptoms improved, with a DS of 5.4 at last follow-up. This was significantly worse than in patients undergoing hypogastric artery bypass, with a DS of 7.8 at last follow-up (P <.001). There was no difference between the groups in duration of procedure, blood loss, length of hospital stay, morbidity, or mortality (0%).
Hypogastric artery bypass to preserve pelvic circulation is safe, and significantly decreases the risk for buttock claudication. Preservation of pelvic circulation results in significant improvement in the ambulatory status of patients with common iliac artery aneurysms, compared with coil embolization.
本研究旨在比较在腹主动脉-髂动脉动脉瘤腔内修复术（EVAR）中，髂内动脉旁路移植术与弹簧圈栓塞术治疗髂总动脉瘤后的功能结局。
1996年至2002年期间，265例患者接受了择期或急诊EVAR。对21例（8%）髂动脉动脉瘤直径达25mm或更大且累及髂动脉分叉的患者的数据进行回顾性分析。患者接受了髂内动脉旁路移植术（n = 9）或弹簧圈栓塞术（n = 12）。对患者过去和当前的活动水平进行了访谈。采用残疾评分（DS）进行定量分级，范围为0至10分，分别对应“几乎卧床不起”至“运动耐量大于1英里”。症状的恶化或改善以两个时间点的DS差异表示（-，恶化；+，改善）。
髂内动脉旁路移植术组与弹簧圈栓塞术组在年龄（72.6±7.3岁 vs 73.1±6.4岁）、性别（男女比例，8:1 vs 11:1）、腹主动脉瘤大小（60.1±5.9mm vs 59.3±7.0mm）或术前合并症数量（1.9±0.8 vs 2.1±0.8）方面均无差异。髂内动脉旁路移植术后的平均随访时间较短（14.8个月 vs 20.5个月；P <.05）。旁路移植术组与栓塞术组的平均总体基线DS无差异（8.0 vs 7.8）。12例接受弹簧圈栓塞术的患者中有6例（50%）报告了与闭塞的髂内动脉同侧的臀部间歇性跛行症状。髂内动脉旁路移植术后未报告臀部间歇性跛行症状（P <.05）。两种手术术后DS均有下降；然而，与髂内动脉旁路移植术相比，弹簧圈栓塞术的DS明显更差（4.5 vs 7.3；P <.001）。6例弹簧圈栓塞术后出现间歇性跛行的患者中有4例（67%）症状改善，末次随访时DS为5.4。这明显差于接受髂内动脉旁路移植术的患者，后者末次随访时DS为7.8（P <.001）。两组在手术持续时间、失血量、住院时间、发病率或死亡率（0%）方面无差异。
保留盆腔循环的髂内动脉旁路移植术是安全的，且显著降低了臀部间歇性跛行的风险。与弹簧圈栓塞术相比，保留盆腔循环可显著改善髂总动脉瘤患者的步行状态。
