Nishizawa Masato, Igari Kimihiro, Katsui Sotaro, Kudo Toshifumi, Uetake Hiroyuki
Department of Specialized Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Ann Vasc Dis. 2020 Jun 25;13(2):144-150. doi: 10.3400/avd.oa.20-00004.
Although aortofemoral bypass (AoFB) is the standard treatment for challenging aortoiliac occlusive disease (AIOD), less-invasive treatments, such as axillofemoral bypass (AxFB) or endovascular treatment (EVT) have been conducted for patients with severe comorbidities. In this study, we compared the clinical outcomes between AxFB and EVT for AIOD. We retrospectively reviewed 9 patients with AxFB and 10 with EVT for challenging AIOD. The patients' information and operative results were evaluated. The rates of patency and limb salvage were analyzed according to the Kaplan-Meier method. In the EVT group, 5 of 10 (50%) patients had aortic stenting alone, 3 (30%) received aorto-uniiliac stenting, and 2 (20%) received aorto-biiliac stenting. In the AxFB group, 2 cases (22.2%) showed acute graft thrombosis; however, in the EVT group, no acute thrombotic complications were seen. The primary patency rates in the AxFB and EVT groups at 5 years were 53.6% and 81.2%, respectively (log rank P=0.225), and the assisted primary patency rates at 5 years were 53.6% and 100%, respectively (log rank P=0.012). EVT exhibited a more durable, better long-term patency rate than AxFB. EVT may, therefore, be a viable treatment alternative to AoFB for challenging AIOD.
尽管主股动脉旁路移植术（AoFB）是治疗复杂主髂动脉闭塞性疾病（AIOD）的标准方法，但对于患有严重合并症的患者，已开展了侵入性较小的治疗方法，如腋股动脉旁路移植术（AxFB）或血管内治疗（EVT）。在本研究中，我们比较了AxFB和EVT治疗AIOD的临床结果。我们回顾性分析了9例行AxFB和10例行EVT治疗复杂AIOD患者的情况。评估了患者信息和手术结果。根据Kaplan-Meier法分析通畅率和肢体挽救率。在EVT组中，10例患者中有5例（50%）仅行主动脉支架置入术，3例（30%）接受主-单侧髂动脉支架置入术，2例（20%）接受主-双侧髂动脉支架置入术。在AxFB组中，2例（22.2%）出现急性移植物血栓形成；然而，在EVT组中，未观察到急性血栓并发症。AxFB组和EVT组5年的主要通畅率分别为53.6%和81.2%（对数秩检验P = 0.225），5年的辅助主要通畅率分别为53.6%和100%（对数秩检验P = 0.012）。与AxFB相比，EVT显示出更持久、更好的长期通畅率。因此，对于复杂AIOD，EVT可能是AoFB的一种可行替代治疗方法。
