York John W, Johnson Brent L, Cicchillo Michael, Taylor Spence M, Cull David L, Kalbaugh Corey
Department of Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina 29605, USA.
Am Surg. 2013 Jan;79(1):61-6. doi: 10.1177/000313481307900131.
Vascular bypass has long been the standard surgical treatment for symptomatic aortoiliac occlusive disease (AIOD). Conventional wisdom has been that aortobifemoral bypass (ABF) be performed for AIOD because of the inevitable progression of iliac atherosclerosis leading to bypass thrombosis. However, ABF is prone to significant groin incision complications such as infection and lymphocele. The purpose of this study was to determine if aortobiiliac bypass (ABI) to the distal external iliac artery performs similarly to ABF in cases in which minimal atherosclerosis is present in the distal iliac arteries. Of patients undergoing aortic reconstruction for symptomatic AIOD between July 1998 and December 2008, 37 were found to have minimal atherosclerosis in the distal external iliac arteries and underwent ABI. These were compared with patients undergoing ABF using a retrospective matched cohort design. The indication for ABI was claudication in 86.5 per cent and critical limb ischemia in 13.5 per cent. There was no difference found in overall bypass patency. The 1-, 3-, and, 5-year patencies were 97, 92, and 79 per cent in the ABI group and 93, 85, and 76 per cent in the ABF group, respectively (P = 0.8). The incidence of groin wound complications in the ABF group was 14.6 per cent. ABI to the distal external iliac artery achieves equivalent graft patencies to ABF without added risk of associated groin wound complications. These data suggest that ABI be preferentially considered to ABF in situations when the very distal external iliac arteries are patent and free of significant atherosclerotic disease.
血管搭桥术长期以来一直是有症状的主髂动脉闭塞性疾病（AIOD）的标准外科治疗方法。传统观点认为，由于髂动脉粥样硬化不可避免地进展会导致搭桥血栓形成，因此应采用主动脉双股动脉搭桥术（ABF）治疗AIOD。然而，ABF容易出现严重的腹股沟切口并发症，如感染和淋巴囊肿。本研究的目的是确定在髂外动脉远端存在最小程度动脉粥样硬化的情况下，主动脉双髂动脉搭桥术（ABI）至髂外动脉远端的效果是否与ABF相似。在1998年7月至2008年12月期间接受主动脉重建治疗有症状AIOD的患者中，有37例被发现髂外动脉远端存在最小程度的动脉粥样硬化，并接受了ABI。使用回顾性匹配队列设计将这些患者与接受ABF的患者进行比较。ABI的适应症为86.5%的间歇性跛行和13.5%的严重肢体缺血。总体搭桥通畅率没有差异。ABI组的1年、3年和5年通畅率分别为97%、92%和79%，ABF组分别为93%、85%和76%（P = 0.8）。ABF组腹股沟伤口并发症的发生率为14.6%。至髂外动脉远端的ABI与ABF的移植物通畅率相当，且不会增加相关腹股沟伤口并发症的风险。这些数据表明，在髂外动脉最远端通畅且无明显动脉粥样硬化疾病的情况下，应优先考虑ABI而非ABF。
