Friedman S G, Kerner B A, Krishnasastry K V, Doscher W, Deckoff S L, Friedman M S
Department of Surgery, North Shore University Hospital, Manhasset, NY.
N Y State J Med. 1990 Apr;90(4):176-8.
In an attempt to analyze whether routine angiography is necessary prior to elective abdominal aortic aneurysmectomy (AAA), a prospective study was designed in which this examination was obtained only for specific indications. These included significant hypertension, renal dysfunction, symptoms of visceral ischemia, suprarenal extension of the aneurysm or a coexisting thoracic aneurysm, and diminished or absent femoral pulses. A consecutive series of 124 abdominal aortic aneurysms is reported, in which 110 procedures were performed electively. Preoperative angiograms were obtained in only ten patients (9.1%) and in nine of these an alteration in the usual operative strategy resulted. In the remaining 100 patients undergoing elective AAA without preoperative aortography, acceptable morbidity and mortality rates were obtained despite the intraoperative discovery of iliac aneurysms in 25 patients (23%) and accessory renal arteries in three patients (2.7%). In the absence of specific indications for angiography, the mainstay of the preoperative evaluation for abdominal aortic aneurysms should be computed tomography (CT). The preoperative workup can be done entirely on an outpatient basis.
为了分析在择期腹主动脉瘤切除术（AAA）之前常规血管造影是否必要，设计了一项前瞻性研究，其中仅针对特定指征进行该项检查。这些指征包括严重高血压、肾功能不全、内脏缺血症状、动脉瘤肾上腺延伸或并存胸主动脉瘤，以及股动脉搏动减弱或消失。报告了连续的124例腹主动脉瘤病例，其中110例为择期手术。仅10例患者（9.1%）进行了术前血管造影，其中9例导致了常规手术策略的改变。在其余100例未进行术前主动脉造影而接受择期AAA手术的患者中，尽管术中发现25例患者（23%）存在髂动脉瘤，3例患者（2.7%）存在副肾动脉，但仍获得了可接受的发病率和死亡率。在没有血管造影特定指征的情况下，腹主动脉瘤术前评估的主要方法应该是计算机断层扫描（CT）。术前检查完全可以在门诊进行。
