Brewster D C, Cambria R P, Darling R C, Athanasoulis C A, Waltman A C, Geller S C, Moncure A C, Lamuraglia G M, Freehan M, Abbott W M
Vascular Surgery Division, Massachusetts General Hospital, Boston.
Ann Surg. 1989 Sep;210(3):324-30; discussion 331. doi: 10.1097/00000658-198909000-00008.
Long-term results of combined use of iliac artery percutaneous transluminal angioplasty (PTA) and distal surgical revascularization for the management of multilevel occlusive disease were evaluated over a 12-year period. A total of 79 combined procedures were performed in 75 patients. All patients had tandem occlusive disease, with the inflow lesion felt to preclude a distal revascularization procedure alone. Revascularization was performed for incapacitating claudication in 17 (22%) and limb salvage indications in 62 (78%) cases. A mean resting iliac artery pressure gradient of 29 +/- 11 mmHg pre-PTA was reduced to 0.9 +/- 0.4 post-PTA. Major complications of PTA occurred in five (6%) cases, but four were successfully corrected at the time of the distal surgical procedure without alteration of the operative plan. Infrainguinal operations included 55 femoropopliteal or tibial bypass grafts, 18 femorofemoral grafts, and 6 profundaplasties. Mean follow-up was 43 months. By life table analysis, the 5-year primary patency rate of the distal surgical procedures was 76%; a secondary patency of 88% at 5 years was achieved by various means of reintervention. Mean pretreatment ankle/brachial index of 0.31 +/- 0.14 increased to 0.80 +/- 0.16 after operation (p less than 0.0001). The 5-year limb salvage rate was 90%. There were no operative deaths. We conclude that in carefully selected patients, combined use of iliac PTA and distal surgical reconstruction is effective and durable, safely reducing the extent of surgical intervention while reliably increasing the comprehensiveness of revascularization.
在12年期间评估了髂动脉经皮腔内血管成形术（PTA）与远端外科血管重建术联合应用治疗多节段闭塞性疾病的长期效果。75例患者共进行了79例联合手术。所有患者均患有串联闭塞性疾病，流入道病变被认为单独进行远端血管重建术是不可行的。17例（22%）因严重跛行、62例（78%）因肢体挽救指征进行了血管重建术。PTA术前髂动脉平均静息压力梯度为29±11 mmHg，术后降至0.9±0.4 mmHg。PTA的主要并发症发生在5例（6%）患者中，但4例在远端外科手术时成功纠正，未改变手术计划。腹股沟下手术包括55例股腘或胫动脉旁路移植术、18例股股动脉旁路移植术和6例股深动脉成形术。平均随访43个月。通过寿命表分析，远端外科手术的5年原发性通畅率为76%；通过各种再次干预手段，5年继发性通畅率达到88%。术前平均踝/臂指数为0.31±0.14，术后升至0.80±0.16（p＜0.0001）。5年肢体挽救率为90%。无手术死亡病例。我们得出结论，在精心挑选的患者中，髂动脉PTA与远端外科重建术联合应用是有效且持久的，能安全地减少手术干预范围，同时可靠地提高血管重建的全面性。
