Milite Domenico, Campanile Francesco, Tosato Federico, Pilon Fabio, Zaramella Massimiliano
Operative Unit of Vascular and Endovascular Surgery, San Bortolo Hospital, Vicenza, Italy.
Interact Cardiovasc Thorac Surg. 2010 May;10(5):749-52. doi: 10.1510/icvts.2009.216846. Epub 2010 Feb 19.
The aim of this study is to assess the immediate and mid-term results of hypogastric artery bypass (HAB) in open repair of abdominal aortic aneurysm (AAA).
The clinical data of 24 patients with an average age of 70.4 years [standard deviation (S.D.)+/-8.1 years] with AAA treated between January 2005 and December 2008 with HAB during open repair of aortoiliac aneurysm were reviewed. Eighteen patients received unilateral and six bilateral hypogastric bypasses, using a segment of Dacron graft prosthesis. Concomitant hypogastric eversion endarterectomy was associated in six cases (25%). Follow-up was complete in all the 24 patients and averaged 16.2 months (range 1-35). Postoperative imaging protocol involved a conventional Echocolordoppler and CT-scan. With respect to the operating time, the blood loss, the intensive care unit (ICU) and the length of ward admission (LWA) stay, we compared the 24 patients who underwent hypogastric bypass (group A) with the 50 patients who had bifurcated graft without hypogastric bypass (group B).
Between the two groups, statistically different results were demonstrated only with respect to the duration of operation (h) (group A 5.19+/-1.38 vs. group B 4.39+/-1.32, P=0.0195). No statistical differences were noted for ICU stay (h) (group A median 21.50 vs. group B median 21.3, range 1 degrees -3 degrees quartile 19.75-23.50) and LWA stay (days) (group A median 8.50, range 1 degrees -3 degrees quartile 7.00-11.50 vs. group B median 8.0, range 1 degrees -3 degrees quartile 7.00-9.00). There were no operative deaths, bowel or intestinal ischemia in the early postoperative period between the two groups. In group A, one patient had transient renal failure and one patient had an acute coronary syndrome. In group B, one patient had a peripheral ischemia who required tibioperoneal embolectomy. The patency of the hypogastric grafts was demonstrated in all cases.
In our experience, direct revascularization of the hypogastric artery to ensure pelvic vascularization in aortoiliac surgery appears a safe procedure.
本研究旨在评估腹主动脉瘤（AAA）开放修复术中下腹动脉搭桥术（HAB）的近期和中期结果。
回顾了2005年1月至2008年12月期间在开放性主髂动脉瘤修复术中接受HAB治疗的24例平均年龄为70.4岁[标准差（S.D.）±8.1岁]的AAA患者的临床资料。18例患者接受单侧下腹动脉搭桥，6例接受双侧下腹动脉搭桥，均使用一段涤纶移植假体。6例（25%）患者同时进行了下腹动脉外翻内膜切除术。24例患者均完成随访，平均随访时间为16.2个月（范围1 - 35个月）。术后影像学检查方案包括传统超声心动图和CT扫描。在手术时间、失血量、重症监护病房（ICU）住院时间和病房住院时间（LWA）方面，我们将24例接受下腹动脉搭桥的患者（A组）与50例接受分叉移植但未进行下腹动脉搭桥的患者（B组）进行了比较。
两组之间，仅在手术持续时间（小时）方面显示出统计学差异（A组5.19±1.38 vs. B组4.39±1.32，P = 0.0195）。ICU住院时间（小时）（A组中位数21.50 vs. B组中位数21.3，第1 - 3四分位数范围19.75 - 23.50）和LWA住院时间（天）（A组中位数8.50,第1 - 3四分位数范围7.00 - 11.50 vs. B组中位数8.0，第1 - 3四分位数范围7.00 - 9.00）无统计学差异。两组术后早期均无手术死亡、肠道或肠缺血情况。A组中，1例患者出现短暂性肾衰竭，1例患者出现急性冠状动脉综合征。B组中，1例患者出现周围缺血，需要进行胫腓动脉取栓术。所有病例中下腹动脉移植血管均通畅。
根据我们的经验，在主髂动脉手术中直接对下腹动脉进行血运重建以确保盆腔血管化似乎是一种安全的手术方法。
