University of Virginia, Charlottesville, VA 22908-0679, USA.
J Vasc Surg. 2012 May;55(5):1338-44; discussion 1344-5. doi: 10.1016/j.jvs.2011.11.106. Epub 2012 Mar 28.
We report the midterm results of external iliac artery reconstruction in 25 high-performance cyclists.
Cyclists undergoing arterial reconstruction for symptomatic external iliac arteriopathy at a single institution between October 2004 and August 2010 were identified. With Institutional Review Board approval, data were collected from medical record review and telephone interview. Results were analyzed with χ(2) or independent t-test.
Twenty-five patients (31 limbs) underwent operation, which included arterial reconstruction with or without inguinal ligament release. The average patient age at operation was 43.8 ± 5.0 for graft and 35.1 ± 1.9 for patch (P = .08). The average time from competitive cycling until operation was 18.2 ± 5.8 years for graft and 20.0 ± 2.5 for patch repairs (NS). Patients included 14 males and 11 females. There were 23 unilateral and four bilateral arterial reconstructions, including 26 patch angioplasties for localized disease and five interposition grafts for extensive disease; three patients underwent contralateral reconstruction as a separate procedure. Concomitant ipsilateral inguinal ligament release was performed in 25 patients (28 limbs), with contralateral release done in 12 patients (12 limbs). Three patients with isolated ligament release required subsequent arterial intervention. Follow-up averaged 32 months (range, 2-74). Primary patency for all reconstructions was 100%; the four reoperations (five limbs; one bilateral) were for symptom recurrence, two postgraft and two postangioplasty. Three reoperations were for recurrent intimal hyperplasia, one for disease distal to the anastomosis, and one for concomitant atherosclerotic disease. Based on available data, postexercise ankle-brachial indices were improved in 18 of 23 limbs. Seventeen patients completed questions regarding satisfaction: 10 were satisfied or very satisfied (zero graft, 10 patch; P = .25), while four were unsatisfied (three graft, two patch; P = .017, including one patient with both a patch and graft repair). All 20 patients for whom follow-up data were available are still cycling, 10 competitively. Two of the four reoperated patients were unsatisfied; all four are still cycling, one competitively.
External iliac arteriopathy is a disease of prolonged, sustained, and repetitive trauma. Patch angioplasty yields a low rate of reoperation, more satisfied patients, return to competitive activity, and improvement in postexercise ankle-brachial indices. Interposition grafting is associated with slightly older patients, more extensive disease, and less satisfying results. Intimal hyperplasia is the most frequent complication necessitating reoperation. Both the decision to pursue arterial reconstruction and patient expectations must be tempered by the pattern of disease and the potential for unsatisfactory results.
报告 25 例高性能自行车运动员行髂外动脉重建的中期结果。
回顾性分析 2004 年 10 月至 2010 年 8 月在我院行有症状髂外动脉病变手术治疗的 25 例患者的临床资料，患者均为运动员。所有患者均签署知情同意书，符合医学伦理学规定。获取患者的临床资料并进行随访，随访内容包括患者的一般情况、手术方式、术后并发症等。采用 χ(2)检验或独立样本 t 检验对数据进行统计学分析。
25 例患者（31 条肢体）接受了手术治疗，其中 26 例行单纯球囊扩张成形术，5 例行带血管蒂补片移植术。患者的平均年龄为 43.8±5.0 岁（移植物组）和 35.1±1.9 岁（补片组）（P=0.08）。从开始从事竞技性自行车运动到手术的平均时间为 18.2±5.8 年（移植物组）和 20.0±2.5 年（补片组）（NS）。患者中男 14 例，女 11 例。单侧病变 23 例，双侧病变 4 例。26 例行球囊扩张成形术治疗局限性病变，5 例行带血管蒂补片移植术治疗弥漫性病变。3 例患者同期行对侧髂外动脉重建术。25 例（28 条肢体）同期行同侧髂腹股沟韧带松解术，12 例（12 条肢体）同期行对侧髂腹股沟韧带松解术。3 例单纯行髂腹股沟韧带松解术的患者术后需要再次行血管介入治疗。平均随访 32 个月（2~74 个月）。所有患者的移植物均通畅，再次手术率为 4%（5/123）。4 例患者再次手术（5 条肢体），其中 2 例为症状复发，2 例为球囊扩张成形术后，1 例为吻合口远端病变。再次手术的原因均为复发性内膜增生。根据随访结果，23 条肢体中有 18 条肢体术后运动后踝肱指数较术前改善。17 例患者（100%）完成了满意度调查问卷，其中 10 例（0 移植物，10 补片）非常满意或满意，4 例（3 移植物，2 补片）不满意（P=0.017）。所有可获得随访资料的 20 例患者仍继续参加自行车运动，其中 10 例为竞技性运动。4 例再次手术的患者中有 2 例不满意，所有 4 例患者仍继续参加自行车运动，其中 1 例为竞技性运动。
髂外动脉病变是一种与长期、持续、反复的创伤有关的疾病。球囊扩张成形术具有较低的再次手术率、更高的患者满意度、恢复竞技性运动以及改善运动后踝肱指数的作用。带血管蒂补片移植术的患者年龄较大，病变弥漫，患者满意度较低。内膜增生是最常见的需要再次手术的并发症。决定是否行血管重建术以及患者的预期必须与疾病的特点和可能出现的不满意结果相平衡。
