Nishibe T, Kondo Y, Dardik A, Muto A, Koizumi J, Nishibe M
Department of Surgery, Fujita Health University, Toyoake, Japan.
J Cardiovasc Surg (Torino). 2009 Aug;50(4):493-9.
The authors described their three-year experience with hybrid surgical and endovascular therapy for multifocal peripheral TASC D lesions, involving both the aortoiliac and/or superficial femoral and common femoral arteries.
From February 2005 to March 2008, 21 lower limbs in 20 patients with multifocal peripheral artery disease, involving the aortoiliac and/or superficial femoral as well as common femoral arteries, were treated by hybrid surgical and endovascular therapy, such as aortoiliac and/or superficial femoral artery stenting as an adjunct to common femoral artery endarterectomy. Technical and hemodynamic success as well as primary and primary assisted patency and limb salvage rates were determined in concordance with the Society for Vascular Surgery guidelines.
All lower limbs successfully underwent successful hybrid surgical and endovascular therapy. The average ABPI before and after hybrid therapy significantly increased from 0.50 +/- 0.32 to 0.79 +/- 0.24 (P = 0.0022). The mean duration of follow-up was 357 days (range, 4 to 1400 days). Over all, the primary patency rates were 94%, 70% and 70% at 6, 12, and 24 months, respectively, and the primary assisted patency rates were 94% at 24 months. The limb salvage rate was 100% at 24 months. The survival rates were 95%, 88%, and 88% at 6, 12, and 24 months, respectively. The primary patency rate for intermittent claudication was significantly higher that that for critical limb ischemia, while no significant difference was found in the assisted primary patency and survival rates between intermittent claudication and critical limb ischemia.
Hybrid surgical and endovascular therapy, such as aortoiliac and/or superficial femoral artery stenting as an adjunct to common femoral artery endarterectomy, can provide a less invasive yet effective and durable option to patients with multifocal peripheral artery disease.
作者描述了他们对多灶性外周TASC D病变采用杂交手术和血管内治疗的三年经验，病变累及主髂动脉和/或股浅动脉及股总动脉。
2005年2月至2008年3月，对20例多灶性外周动脉疾病患者的21条下肢进行了杂交手术和血管内治疗，病变累及主髂动脉和/或股浅动脉以及股总动脉，如主髂动脉和/或股浅动脉支架置入作为股总动脉内膜切除术的辅助治疗。根据血管外科学会指南确定技术和血流动力学成功率以及初次和初次辅助通畅率和肢体挽救率。
所有下肢均成功接受了杂交手术和血管内治疗。杂交治疗前后的平均踝肱指数（ABPI）从0.50±0.32显著提高到0.79±0.24（P = 0.0022）。平均随访时间为357天（范围4至1400天）。总体而言，6个月、12个月和24个月时的初次通畅率分别为94%、70%和70%，24个月时的初次辅助通畅率为94%。24个月时肢体挽救率为100%。6个月、12个月和24个月时的生存率分别为95%、88%和88%。间歇性跛行的初次通畅率显著高于严重肢体缺血患者，而间歇性跛行和严重肢体缺血患者的辅助初次通畅率和生存率无显著差异。
杂交手术和血管内治疗，如主髂动脉和/或股浅动脉支架置入作为股总动脉内膜切除术的辅助治疗，可为多灶性外周动脉疾病患者提供一种侵入性较小但有效且持久的选择。
