Centre for Surgical Research, University of Bristol, Bristol, UK.
St George's University Hospitals NHS Foundation Trust, London, UK.
Eur J Vasc Endovasc Surg. 2018 Apr;55(4):577-583. doi: 10.1016/j.ejvs.2018.01.018. Epub 2018 Mar 13.
OBJECTIVE/BACKGROUND: The objective was to summarise the lessons learned, and evolution in local practice over the last 7 years, in the investigation and surgical management of iliac artery endofibrosis.
This was a retrospective case series. A case note review of consecutive patients investigated for suspected iliac artery endofibrosis by a single surgeon, over a 7 year period, was undertaken. Included were cases of first presentation and those who had previously undergone intervention.
Some 63 patients were referred with suspected endofibrosis in the period 2011-17, four of whom had previously undergone surgery for the condition. After investigation of both limbs, 50 symptomatic limbs in 46 patients had a confirmed diagnosis; amongst those 46 patients, iliac artery endofibrosis was found in a further six asymptomatic, contralateral limbs. Individuals were diagnosed at a median age of 36 years (range 18-52 years) and typically presented with thigh claudication, foot numbness, and limb weakness on exercise. The median delay to diagnosis was 3 years (range 0-14 years). Complete external iliac artery occlusion was a feature in three cases. Overall, 27 limbs in 25 patients underwent operative repair; a further five limbs in four patients underwent operative repair at other centres internationally. There were three post-operative superficial wound infections (11%) and one below knee deep vein thrombosis (4%). Symptoms resolved in 23 cases (85%) with a median follow up of 2.1 years (range 65 days-5.7 years). Of the four limbs developing recurrent symptoms, two had undergone surgery for an occluded external iliac artery.
Surgical repair in the medium term appears effective in resolving symptoms in most patients. Further investigation is needed to establish the durability of surgery and to delineate the natural history of the disease.
目的/背景：目的是总结过去 7 年来在髂动脉内膜纤维化的检查和手术治疗方面的经验教训和实践演变。
这是一项回顾性病例系列研究。对一名外科医生在过去 7 年期间连续对疑似髂动脉内膜纤维化患者进行调查的病例记录进行了回顾性分析。包括首次就诊的病例和之前接受过治疗的病例。
在 2011-17 年期间，共有 63 例患者因疑似内膜纤维化而被转介，其中 4 例曾因该疾病接受过手术治疗。对双侧肢体进行检查后，46 例中有 50 例症状性肢体确诊；在这 46 例患者中，又有 6 例无症状的对侧髂动脉发现内膜纤维化。患者的中位年龄为 36 岁（范围 18-52 岁），典型表现为大腿跛行、足部麻木和运动时肢体无力。中位诊断延迟时间为 3 年（范围 0-14 年）。3 例完全性髂外动脉闭塞。总体而言，25 例患者中的 27 条肢体接受了手术修复；另外 4 例患者中的 5 条肢体在国际上的其他中心接受了手术修复。术后有 3 例发生浅表伤口感染（11%），1 例发生膝下深静脉血栓形成（4%）。23 例（85%）症状缓解，中位随访时间为 2.1 年（范围 65 天-5.7 年）。4 例出现症状复发的肢体中，有 2 例因髂外动脉闭塞而行手术治疗。
中期手术修复在大多数患者中似乎能有效缓解症状。需要进一步研究以确定手术的耐久性，并阐明疾病的自然病程。
