Lun Yu, Zhang Jian, Wu Xiaoyu, Gang Qingwei, Shen Shikai, Jiang Han, Duan Zhiquan, Xin Shijie
Department of Vascular Surgery, The First Hospital, China Medical University, Nanjing Bei Str. 155, Shenyang 110001, China.
Department of Vascular Surgery, The First Hospital, China Medical University, Nanjing Bei Str. 155, Shenyang 110001, China.
J Vasc Interv Radiol. 2015 Feb;26(2):196-204. doi: 10.1016/j.jvir.2014.10.018. Epub 2014 Dec 17.
To compare the midterm results of aortoiliac stent (AIS) placement with those of surgical treatment in patients with chronic infrarenal aortoiliac occlusion.
Midterm outcomes in patients treated at a single center from 2005 to 2010 were retrospectively reviewed. Correlations between baseline clinical factors and midterm outcomes were assessed.
The technical success rate was significantly lower in the AIS group than in the surgery group (83.3% vs 100%; P = .016). Of 68 technically successfully treated patients, 33 underwent surgical revascularization and 35 received AIS placement. There were no significant differences in patient demographics, Rutherford classification, cardiovascular risk factors, and 30-day mortality rates. Surgically treated patients had a longer average postoperative hospital stay (P = .001) and higher rates of postoperative complications, including respiratory failure (P = .010), transient renal dysfunction (P = .002), and multiple organ dysfunction (P = .023). Mean ankle-brachial index increased significantly in both groups (P < .001), but to the same extent. The primary 1-, 3-, and 5-year patency rates were 93.6%, 90.2%, and 90.2%, respectively, in the surgery group, and 91.4%, 81.8%, and 64.2%, respectively, in the AIS group (P = .054). No differences were observed in survival rate (P = .945), limb salvage (P = .860), or secondary patency (P = .916).
AIS for chronic infrarenal aortoiliac occlusion is associated with a shorter hospital stay and lower postoperative morbidity rates. Although midterm primary patency rate was lower than for traditional open surgery, AIS appears to be a safe, minimally invasive, and reliable procedure for patients with chronic infrarenal aortoiliac occlusion.
比较慢性肾下腹主动脉-髂动脉闭塞患者行主动脉-髂动脉支架置入术（AIS）与手术治疗的中期结果。
回顾性分析2005年至2010年在单一中心接受治疗的患者的中期结局。评估基线临床因素与中期结局之间的相关性。
AIS组的技术成功率显著低于手术组（83.3%对100%；P = 0.016）。在68例技术成功治疗的患者中，33例行手术血运重建，35例接受AIS置入。患者人口统计学、卢瑟福分类、心血管危险因素和30天死亡率无显著差异。手术治疗的患者术后平均住院时间更长（P = 0.001），术后并发症发生率更高，包括呼吸衰竭（P = 0.010）、短暂性肾功能不全（P = 0.002）和多器官功能障碍（P = 0.023）。两组的平均踝肱指数均显著升高（P < 0.001），但升高幅度相同。手术组1年、3年和5年的原发性通畅率分别为93.6%、90.2%和90.2%，AIS组分别为91.4%、81.8%和64.2%（P = 0.054）。生存率（P = 0.945）、肢体挽救率（P = 0.860）或继发性通畅率（P = 0.916）无差异。
慢性肾下腹主动脉-髂动脉闭塞行AIS与住院时间缩短和术后发病率降低相关。尽管中期原发性通畅率低于传统开放手术，但AIS似乎是慢性肾下腹主动脉-髂动脉闭塞患者的一种安全、微创且可靠的手术方法。
