Vascular Unit, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
Eur J Vasc Endovasc Surg. 2010 Mar;39 Suppl 1:S25-31. doi: 10.1016/j.ejvs.2009.12.028. Epub 2010 Feb 26.
The aim of the study was to describe the presentation management and short term results of therapy (< 1 month) in patients admitted with HIV vasculopathy. Records were culled from a prospectively maintained data base on the Vascular Unit at Inkosi Albert Luthuli Hospital, Durban, South Africa between January 2005 and June 2009. 226 patients were studied; 111 had aneurysms and 115 occlusive disease. 98% were African and ages ranged from 4-53 years (average 36); 90% were male. The CD4 count ranged from 1-930 cells/mm(3) while serum albumin averaged 30 mMol/L. 202 aneurysm presented in 111 participants; commonest sites were superficial femoral artery (40%) and carotid (25%). 82 patients had standard operative repair and 8 had stent grafts; 29 were not treated due to advanced disease. Within 30 days of operation the mortality was 9% with 5% developing graft sepsis and 11% pulmonary complications. Of 115 with occlusive disease, there were 2 distinct groups. 51 had no previous claudication and had acute thrombosis; no thrombophilia could be demonstrated. 64 had premature atherosclerotic disease. The majority presented with critical ischaemia. In the acute thrombosis group 15 (29%) had primary amputation, limb salvage was achieved in 13 (36%) and 4 died (11%). In the chronic occlusive group 30 (47%) had primary amputation, of 25 submitted to surgery limb salvage was achieved in 17 (68%). Low CD4 count and albumin levels did not correlate with mortality or complications.
Surgical therapy for aneurysm is worthwhile in the short term. Following occlusive disease there is a 25% overall salvage rate in the short term (< 1/12) but the long term outlook is uncertain.
本研究旨在描述 HIV 血管病患者的就诊管理和短期治疗（<1 个月）结果。资料来源于 2005 年 1 月至 2009 年 6 月期间南非德班 Inkosi Albert Luthuli 医院血管科前瞻性维护的数据。研究共纳入 226 例患者，其中 111 例为动脉瘤，115 例为闭塞性疾病。98%为非洲裔，年龄 4-53 岁（平均 36 岁），90%为男性。CD4 计数范围为 1-930 个细胞/mm3，血清白蛋白平均值为 30 mMol/L。202 例动脉瘤见于 111 例患者中，最常见的部位为股浅动脉（40%）和颈动脉（25%）。82 例患者接受标准手术修复，8 例患者接受支架移植，29 例患者因疾病晚期未予治疗。术后 30 天内死亡率为 9%，其中 5%出现移植物感染，11%出现肺部并发症。115 例闭塞性疾病患者可分为两组，51 例患者既往无间歇性跛行，发生急性血栓形成，无血栓形成倾向；64 例患者存在早发性动脉粥样硬化疾病，大多数患者表现为严重缺血。急性血栓形成组中 15 例（29%）行初次截肢，13 例（36%）实现保肢，4 例（11%）死亡。慢性闭塞组中 30 例（47%）行初次截肢，25 例行手术治疗的患者中 17 例（68%）实现保肢。低 CD4 计数和白蛋白水平与死亡率或并发症无关。
短期内，动脉瘤的手术治疗是值得的。闭塞性疾病患者的短期（<1/12）总体保肢率为 25%，但长期预后不确定。
