Yurdakul Mehmet, Tola Muharrem, Ozdemir Ensar, Bayazit Murat, Cumhur Turhan
Department of Radiology, Türkiye Yüksek Ihtisas Hospital, Sihhiye Ankara, Turkey.
J Vasc Surg. 2006 Apr;43(4):707-13. doi: 10.1016/j.jvs.2005.12.042.
In patients with aortoiliac occlusion, the internal thoracic artery-inferior epigastric artery (ITA-IEA) collateral is one of the collaterals supplying blood flow to the lower extremity, and the interruption of this collateral may cause severe leg ischemia. The aim of this study was to evaluate by color duplex ultrasonography scans the ITA-IEA pathway and its significance as a collateral in providing lower-extremity perfusion in aortoiliac occlusive disease.
Color duplex ultrasonography scans were prospectively performed in 64 consecutive patients with aortoiliac occlusion. Blood flow measurement in the ITA, IEA, and common femoral artery was done on both sides. The patients were stratified according to occlusion level (aorta, common iliac artery, external iliac artery), and the data obtained from such groups were compared.
In 95% of patients with aortoiliac occlusion, the ITA-IEA pathway was functioning as a collateral, with mean collateral flow of 66 +/- 48 mL/min, and its average contribution to lower-extremity perfusion was 38% +/- 23%. Additionally, a moderately positive correlation was found between flows of ITA and IEA (r = 0.55, P < .0001). Depending on the level of occlusion, the collateral flow and its contribution to perfusion progressively decreased from the proximal to distal aortoiliac occlusion level. Furthermore, the difference in the ITA-IEA flow volume was statistically significant between occlusion levels (P = .009), but the differences in the perfusion contribution were not different among levels (P = .311). There was also no statistical difference between the groups concerning collateral flow volume and contribution to lower-extremity perfusion in relation to unilateral or bilateral occlusion of the iliac artery, the state of distal run-off being good or poor, or the clinical findings being mild or severe.
In patients with aortoiliac occlusion, the ITA-IEA collateral pathway is an important route providing lower-extremity perfusion. Additionally, Doppler sonographic flow measurements of the contribution of the ITA-IEA route to lower-extremity perfusion may provide beneficial diagnostic information necessary for the pretreatment work-up of patients with aortoiliac occlusion, especially for whom the ITA is planned to be used as a coronary artery graft.
在主髂动脉闭塞患者中，胸廓内动脉-腹壁下动脉（ITA-IEA）侧支是向下肢供血的侧支之一，该侧支的中断可能导致严重的下肢缺血。本研究的目的是通过彩色双功超声扫描评估ITA-IEA通路及其作为主髂动脉闭塞性疾病中为下肢提供灌注的侧支的意义。
对64例连续的主髂动脉闭塞患者进行前瞻性彩色双功超声扫描。对双侧的ITA、IEA和股总动脉进行血流测量。根据闭塞水平（主动脉、髂总动脉、髂外动脉）对患者进行分层，并比较从这些组获得的数据。
在95%的主髂动脉闭塞患者中，ITA-IEA通路作为侧支发挥作用，平均侧支血流为66±48 mL/min，其对下肢灌注的平均贡献为38%±23%。此外，ITA和IEA的血流之间存在中度正相关（r = 0.55，P <.0001）。根据闭塞水平，侧支血流及其对灌注的贡献从近端到远端主髂动脉闭塞水平逐渐降低。此外，ITA-IEA血流量在闭塞水平之间的差异具有统计学意义（P =.009），但灌注贡献在各水平之间的差异无统计学意义（P =.311）。在髂动脉单侧或双侧闭塞、远端流出道状态良好或不良、临床表现为轻度或重度方面，侧支血流量和对下肢灌注的贡献在各组之间也无统计学差异。
在主髂动脉闭塞患者中，ITA-IEA侧支通路是提供下肢灌注的重要途径。此外，通过多普勒超声测量ITA-IEA通路对下肢灌注的贡献可能为患有主髂动脉闭塞的患者的预处理评估提供有益的诊断信息，特别是对于计划将ITA用作冠状动脉移植物的患者。
