Maitrias Pierre, Deltombe Gwendoline, Molin Valérie, Reix Thierry
Department of Vascular Surgery, Amiens University Hospital, Amiens, France; Medicine College, Jules Verne University of Picardie, Amiens, France; INSERM Unit 1088, Pathophysiological Mechanisms and Consequences of Cardiovascular Calcifications, University Health Research Center, Amiens, France.
Department of Vascular Surgery, Amiens University Hospital, Amiens, France.
J Vasc Surg. 2017 Feb;65(2):406-413. doi: 10.1016/j.jvs.2016.07.130. Epub 2016 Sep 29.
Iliofemoral endarterectomy with external iliac artery (EIA) stent grafting can be an alternative to traditional open surgery in patients with severe iliac occlusive disease extending to the common femoral artery. We report the midterm outcomes of this approach.
Between 2009 and 2015, 108 patients (76% male; median age, 63 years) underwent a total of 127 iliofemoral endarterectomies combined with EIA stent grafting. Indications were claudication in 60%, rest pain in 20%, ulceration in 15%, and acute ischemia in 5%. Lesions exclusively involved only the EIA segment in 40% of cases, with occlusion in 28%. Lesions involved both the EIA and common iliac artery segments in 49% of cases, with 19% of common iliac artery occlusions and 24% of EIA occlusions. Iliac lesions extended into the aortic segment in 11% of cases. Iliofemoral endarterectomy was performed by eversion whenever possible. Deployment of the EIA stent graft systematically incorporated the EIA segment and the proximal end of the endarterectomy. Self-expanding covered stents were calibrated to the diameter of the endarterectomized EIA.
The procedure was technically successful in 100% of patients. Median diameter of covered stents was 8 mm (range, 6-10 mm). No intraoperative arterial rupture or dissection was observed. Early reoperations (3%) were performed for bleeding, infection, or thrombosis. Median length of stay was 5 days. No 30-day mortality was observed. Median follow-up was 30 months (range, 0-6 years), and overall mortality was 13% (due to cancer in half of the cases). Repeated angioplasty was performed in three (2%) cases, and a subsequent open procedure on the iliofemoral segment was performed in seven (5%) cases. At 2 years, primary patency rate of the treated segment was 91%. The 2-year primary assisted patency and secondary patency rates were 94% and 98%, respectively. Five-year primary, primary assisted, and secondary patency rates were 87%, 92%, and 98%, respectively.
Combined iliofemoral endarterectomy and covered stenting of the EIA for treatment of severe occlusive lesions provided acceptable midterm results, probably because of the gain of diameter provided by covered stents. This technique avoids complications due to an aortic or iliac surgical approach and clamping as well as complications related to the presence of a prosthetic implant in an intra-abdominal position.
对于严重髂动脉闭塞性疾病累及股总动脉的患者，髂股动脉内膜切除术联合髂外动脉（EIA）支架植入术可作为传统开放手术的替代方法。我们报告了该方法的中期结果。
2009年至2015年期间，108例患者（男性占76%；中位年龄63岁）共接受了127次髂股动脉内膜切除术联合EIA支架植入术。适应症包括60%为间歇性跛行，20%为静息痛，15%为溃疡，5%为急性缺血。40%的病例病变仅累及EIA段，其中28%为闭塞。49%的病例病变累及EIA和髂总动脉段，髂总动脉闭塞占19%，EIA闭塞占24%。11%的病例髂动脉病变延伸至主动脉段。只要有可能，就采用外翻法进行髂股动脉内膜切除术。EIA支架植入系统地覆盖了EIA段和内膜切除术的近端。自膨式覆膜支架根据内膜切除术后EIA的直径进行校准。
该手术在100%的患者中技术成功。覆膜支架的中位直径为8mm（范围6 - 10mm）。未观察到术中动脉破裂或夹层。因出血、感染或血栓形成进行早期再次手术的比例为3%。中位住院时间为5天。未观察到30天死亡率。中位随访时间为30个月（范围0 - 6年），总死亡率为13%（半数病例死于癌症）。3例（2%）患者进行了重复血管成形术，7例（5%）患者随后对髂股段进行了开放手术。2年时，治疗段的一期通畅率为91%。2年的一期辅助通畅率和二期通畅率分别为94%和98%。5年的一期、一期辅助和二期通畅率分别为87%、92%和9
