Vascular and Thoracic Surgery Department, Vascular and Sports Medicine Laboratory, University Hospital of Angers, Cedex 09, France.
Eur J Vasc Endovasc Surg. 2011 Jul;42(1):78-82. doi: 10.1016/j.ejvs.2011.03.014. Epub 2011 Apr 30.
Various indications for internal iliac artery (IIA) revascularisation have been reported. Revascularisations for gluteal ischaemia and buttock claudication remain controversial and uncommon. The objective of the study was to assess the patency of direct conventional revascularisations (CRs) of the IIA in patients with aortoiliac occlusive disease because few studies have focussed on this specific topic.
The charts of all patients who underwent CR of the IIA, between August 2000 and January 2009, were retrospectively reviewed. We recorded for each patient preoperative vascular work-up. All patients were tested for patency on January 2009. A computed tomography (CT) scan was requested if the duplex scan casts any doubt with regard to patency. If non-patent, the last date for confirmed patency was kept for the analysis. Functional outcomes at the proximal level were also collected.
We studied 40 patients with occlusive disease. Buttock claudication was observed in 27 patients (66%), including eight (20%) in whom these symptoms were isolated. The 13 other patients had distal claudication or rest pain and documented proximal ischaemia, justifying the IIA revascularisations. We performed 44 conventional direct revascularisations of the IIA concomitant to aorto- or iliofemoral bypasses in these patients. The overall postoperative patency rate was 89%. Five early occlusions of the IIA remained asymptomatic. The median duration of follow-up was 39 months (3-86 months). The survival rate was 95% at 1 year and 86% at 5 years. The primary patency rate of the IIA was 89% at 1 year and 72.5% at 5 years. Buttock claudication disappeared in 23 of the 27 patients (85%), who were symptomatic at the proximal level prior to surgery.
Direct IIA concomitant revascularisation has an acceptable patency rate in patients undergoing aorto- or iliofemoral bypasses for occlusive disease. When feasible, this technique appears to be safe for the treatment and prevention of buttock claudication.
已有多种关于髂内动脉（IIA）血管重建的适应证的报道。臀肌缺血和臀部跛行的血管重建仍然存在争议，且并不常见。本研究的目的是评估在主髂动脉闭塞性疾病患者中直接常规重建（CR）IIA 的通畅率，因为很少有研究专注于这一特定主题。
回顾性分析 2000 年 8 月至 2009 年 1 月期间接受 IIA CR 的所有患者的病历。我们记录了每位患者术前的血管检查。所有患者于 2009 年 1 月进行了通畅性检测。如果双功能超声检查对通畅性有任何疑问，则要求进行计算机断层扫描（CT）检查。如果不通，则记录最后一次确认通畅的日期进行分析。近端水平的功能结果也被收集。
我们研究了 40 例主髂动脉闭塞性疾病患者。27 例（66%）患者出现臀肌跛行，其中 8 例（20%）孤立存在这些症状。其余 13 例患者有下肢跛行或静息痛，并有近端缺血的影像学证据，这证明了 IIA 血管重建的必要性。我们对这些患者同时进行了 44 例 IIA 常规直接 CR 和主髂旁路手术。术后总体通畅率为 89%。5 例 IIA 早期闭塞且无症状。中位随访时间为 39 个月（3-86 个月）。1 年和 5 年的生存率分别为 95%和 86%。1 年和 5 年时 IIA 的原发性通畅率分别为 89%和 72.5%。27 例有症状的患者（85%）术前存在近端水平跛行，术后臀肌跛行均消失。
在主髂动脉旁路手术中同时进行直接 IIA 血管重建，其通畅率可接受。在可行的情况下，该技术似乎是安全的，可用于治疗和预防臀肌跛行。
