Piotrowski J J, Pearce W H, Jones D N, Whitehill T, Bell R, Patt A, Rutherford R B
Department of Surgery, University of Colorado Health Sciences Center, Denver 80262.
J Vasc Surg. 1988 Sep;8(3):211-8. doi: 10.1067/mva.1988.avs0080211.
Aortobifemoral bypass (ABF) is the preferred operation for patients with bilateral aortoiliac occlusive disease, but for those with unilateral occlusion without significant stenosis of the contralateral iliac artery, alternative reconstructions, such as femorofemoral (FF) or iliofemoral (IF) bypass have been advocated. We compared the surgical outcome in 96 such patients after ABF (n = 32), FF (n = 47), or IF (n = 17) bypasses, with biplane arteriography and noninvasive laboratory testing used to assess the contralateral iliac artery and runoff status, in particular, patency of the superficial femoral artery (SFA). Graft patencies were assessed by noninvasive criteria and analyzed by the life-table method. The only death occurred after ABF bypass (3.1%). Primary patency rates at 1, 3, and 5 years with an open SFA were 100%, 89% and 89%, respectively, for ABF; 92%, 92%, and 92% for FF; and 71%, 71%, and 36% for IF. When the SFA was occluded, the primary patency rates at 1, 3, and 5 years were 100%, 100%, and 72%, respectively, for ABF; 72%, 53%, and 35% for FF; and 56%, 56%, and 56% for IF bypasses. There were no later occlusions on the contralateral ("good") side after ABF. Significant progression of atherosclerosis in donor iliac artery was observed in 6% of both FF and IF bypasses. We conclude that ABF is the preferred operation for extensive iliac artery occlusive disease that is hemodynamically significant only on the symptomatic side unless specifically contraindicated by prohibitive risk or abdominal disease. This is particularly true in the face of SFA occlusion.
主-双股动脉搭桥术（ABF）是双侧主-髂动脉闭塞性疾病患者的首选手术方式，但对于那些单侧闭塞且对侧髂动脉无明显狭窄的患者，有人主张采用诸如股-股（FF）或髂-股（IF）搭桥等替代重建方法。我们比较了96例接受ABF（n = 32）、FF（n = 47）或IF（n = 17）搭桥术的此类患者的手术结果，采用双平面动脉造影和非侵入性实验室检查来评估对侧髂动脉和下肢动脉流出道情况，尤其是股浅动脉（SFA）的通畅情况。通过非侵入性标准评估移植物通畅情况，并采用寿命表法进行分析。仅1例死亡发生在ABF搭桥术后（3.1%）。当SFA通畅时，ABF术后1年、3年和5年的原发性通畅率分别为100%、89%和89%；FF术后分别为92%、92%和92%；IF术后分别为71%、71%和36%。当SFA闭塞时，ABF术后1年、3年和5年的原发性通畅率分别为100%、100%和72%；FF术后分别为72%、53%和35%；IF搭桥术后分别为56%、56%和56%。ABF术后对侧（“正常”）侧未出现后期闭塞。FF和IF搭桥术后均有6%的供体髂动脉出现动脉粥样硬化显著进展。我们得出结论，对于仅在有症状侧具有血流动力学意义的广泛性髂动脉闭塞性疾病，ABF是首选手术方式，除非存在极高风险或腹部疾病等明确禁忌证。面对SFA闭塞时尤其如此。
