Jonsson Thomas, Larzon Thomas, Jansson Kjell, Arfvidsson Berndt, Norgren Lars
Department of Surgery, Orebro University Hospital, Orebro, Sweden.
J Endovasc Ther. 2008 Dec;15(6):695-701. doi: 10.1583/08-2476.1.
To evaluate the splanchnic and limb metabolic effects of open repair (OR) of abdominal aortic aneurysms (AAA) versus endovascular aneurysm repair (EVAR) in a pilot study utilizing microdialysis.
Nine AAA patients (8 men; mean age 74 years, range 61-85) were treated with EVAR and 9 had an OR (5 men; mean age 70 years, range 55-85). In the EVAR cases, which were performed percutaneously, the external iliac artery was obstructed by the introducer to a mean functional stenosis of 70% (52%-100%). Catheters for microdialysis were placed subcutaneously above the ankle of the right leg and freely in the abdominal cavity to measure the levels of lactate and pyruvate. The lactate/pyruvate ratio was calculated as a measure of ischemia. Measurements started at the end of surgery and continued for 2 days. Mean values were compared using the Mann-Whitney U test.
The mean value of intraperitoneal lactate during the first day after EVAR was 1.5+/-0.7 mM versus 2.6+/-0.8 mM after OR (p = 0.019). The lactate/pyruvate ratio was 10.2+/-2.2 after EVAR and 12.3+/-2.6 after OR (p = 0.113). Leg lactate mean values were 4.2+/-2.0 mM after EVAR versus 1.8+/-0.6 mM after OR (p<0.001). The lactate/pyruvate ratio was 20.1+/-8.3 for EVAR and 13.7+/-3.3 for OR (p = 0.040). These differences between EVAR and OR continued for the second day.
Intraperitoneally, metabolism was slightly increased after OR; however, it was not suggestive of splanchnic ischemia. Leg findings reflected a more extensive ischemia after EVAR over 48 hours, which was a somewhat unexpected finding that may be related to the introducer's impact on blood flow to the limb during the intervention. Although no clinical consequences were recorded, the finding suggests some benefit of minimizing as much as possible the time of reduced perfusion to the limb.
在一项利用微透析的初步研究中，评估腹主动脉瘤（AAA）开放修复术（OR）与血管内动脉瘤修复术（EVAR）对内脏和肢体代谢的影响。
9例AAA患者（8例男性；平均年龄74岁，范围61 - 85岁）接受了EVAR治疗，9例接受了OR治疗（5例男性；平均年龄70岁，范围55 - 85岁）。在经皮进行的EVAR病例中，髂外动脉被导入器阻塞，导致平均功能性狭窄70%（52% - 100%）。将微透析导管皮下置于右腿踝部上方，并自由放置于腹腔内，以测量乳酸和丙酮酸水平。计算乳酸/丙酮酸比值作为缺血的指标。测量从手术结束时开始，持续2天。使用Mann - Whitney U检验比较平均值。
EVAR术后第一天腹腔内乳酸平均值为1.5±0.7 mM，而OR术后为2.6±0.8 mM（p = 0.019）。EVAR术后乳酸/丙酮酸比值为10.2±2.2，OR术后为12.3±2.6（p = 0.113）。EVAR术后腿部乳酸平均值为4.2±2.0 mM，OR术后为1.8±0.6 mM（p<0.001）。EVAR的乳酸/丙酮酸比值为20.1±8.3，OR为13.7±3.3（p = 0.040）。EVAR和OR之间的这些差异在第二天持续存在。
在腹腔内，OR术后代谢略有增加；然而，这并不提示内脏缺血。腿部的结果反映出EVAR术后48小时内缺血更为广泛，这是一个 somewhat unexpected finding that may be related to the introducer's impact on blood flow to the limb during the intervention. Although no clinical consequences were recorded, the finding suggests some benefit of minimizing as much as possible the time of reduced perfusion to the limb. （此处原文表述有误，正确的英文应该是“a somewhat unexpected finding that may be related to the impact of the introducer on blood flow to the limb during the intervention. Although no clinical consequences were recorded, the finding suggests some benefit in minimizing as much as possible the time of reduced perfusion to the limb.”，翻译为“这是一个有些意外的发现，可能与介入过程中导入器对肢体血流的影响有关。尽管未记录到临床后果，但这一发现表明尽可能缩短肢体灌注减少的时间有一定益处。”）
