Bacourt F, Lenot B, Goeau-Brissonnière O, Koskas F
Hôpital Américain, Neuilly.
J Chir (Paris). 1991 Nov;128(11):459-64.
From 1980 to 1990, 101 limbs were revascularized at the upper level only in 67 patients, while they presented with associated aortoiliac and femoral obstructive lesions. The symptoms disappeared after aortofemoral revascularization in 94% of the limbs operated on for claudication and 80% of those operated on for critic ischemia. Surgery of the deep femoral artery was associated in 51% of all cases. The average time lapse is 58 months. No complementary revascularization was needed in the cases of claudication. Out of the patients operated on for critic ischemia, upper revascularization was insufficient in 8 cases. Two of the operated patients were cured after secondary downstream revascularization (4%). Three operated patients still presented with intermittent claudication (6%), and 3 were amputed due to acute iliac obstruction seen at an advanced stage. As no reliable predictive test is available, we find it justified to carry out only upper revascularisation in most cases and to decide on the need for secondary downstream extension according to the clinical outcome. However, simultaneous revascularization at both levels is required in case of extensive involvement of the deep femoral artery, such as observed in only 5 of the patients operated during the same period.
1980年至1990年期间，67例患者仅在上肢进行了101次血管重建手术，这些患者同时伴有腹主动脉髂动脉和股动脉阻塞性病变。在接受手术治疗间歇性跛行的肢体中，94%在进行主动脉股动脉血管重建术后症状消失；在接受手术治疗严重缺血的肢体中，这一比例为80%。51%的病例同时进行了股深动脉手术。平均随访时间为58个月。间歇性跛行患者无需进行二次血管重建。在接受手术治疗严重缺血的患者中，8例上肢血管重建不足。2例患者在进行二次下游血管重建后治愈（4%）。3例手术患者仍有间歇性跛行（6%），3例因晚期出现急性髂动脉阻塞而截肢。由于没有可靠的预测性检查，我们认为在大多数情况下仅进行上肢血管重建是合理的，并根据临床结果决定是否需要进行二次下游血管延伸。然而，在股深动脉广泛受累的情况下，如同期手术的患者中仅有5例观察到的情况，需要同时进行两个层面的血管重建。
