Yadav Rajeshwar, Pathak Swati, Hegde Satisha
Department of Cardiovascular and Thoracic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND.
Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND.
Cureus. 2022 Aug 2;14(8):e27595. doi: 10.7759/cureus.27595. eCollection 2022 Aug.
Purpose Atherosclerosis is a generalized disorder and can begin to develop in the abdominal aorta by the second decade of life. The nature of these lesions in coronaries and aorta is atheromatous and less sclerotic when compared to peripheral arteries. A broad spectrum of presentations and different types of lesions demand a personalized approach for the best outcome. This study is a case series analysis of major vascular revascularization. We aim to study various revascularization surgeries and underline the wide range of vascular lesions to which it is applied. Methods This is a study based on accrual patient records of all major vascular revascularization surgical/interventional procedures conducted at a tertiary care center for one year. Results A total of 110 patients were operated on for vascular diseases. Among these, 86 (78.81%) were men, and 24 (21.81%) were women. The femoropopliteal segment (n=47) was most commonly involved, followed by the common carotid artery (n=20). Atherosclerosis was the main cause of vascular occlusion (81.8%), followed by aneurysm of the aorta (14.5%) and coarctation of the aorta (2.7%). Smoking (62.2%) accounted to be the leading risk factor, followed by hypertension, diabetes, and hyperlipidemia. The majority of patients had a good outcome (92.7%). Minor complications (7.3%) include seroma formation and wound infection, which were managed conservatively. The repair was performed by autologous vein graft in 30% of patients and by synthetic polytetrafluoroethylene (PTFE) graft in 70% of patients. Carotid artery stenting was the most common endovascular procedure performed (n=5). Femoropopliteal bypass grafting was the most common procedure, followed by carotid endarterectomy (n=20) and aortofemoral bypass (n=14). Conclusion The application of novel techniques such as cavo-atrial shunt in Budd-Chiari syndrome calls attention to the broadened scope of vascular surgery, and the modification of the conventional method of the carotid endarterectomy underscores the evolution of vascular revascularization. Our study thus highlighted that a wide spectrum of vascular lesions ranging from carotid artery stenosis to extensive below-knee disease, either atherosclerotic or aneurysmal, can be successfully treated with surgical revascularization techniques.
目的 动脉粥样硬化是一种全身性疾病,在生命的第二个十年就可能开始在腹主动脉中发展。与外周动脉相比,冠状动脉和主动脉中这些病变的性质是动脉粥样硬化性的,硬化程度较低。广泛的临床表现和不同类型的病变需要个性化的方法以获得最佳结果。本研究是一项关于主要血管血运重建的病例系列分析。我们旨在研究各种血运重建手术,并强调其应用的广泛血管病变范围。
方法 这是一项基于某三级医疗中心一年内进行的所有主要血管血运重建手术/介入操作的累积患者记录的研究。
结果 共有110例患者接受了血管疾病手术。其中,男性86例(78.81%),女性24例(21.81%)。股腘段(n = 47)受累最为常见,其次是颈总动脉(n = 20)。动脉粥样硬化是血管闭塞的主要原因(81.8%),其次是主动脉瘤(14.5%)和主动脉缩窄(2.7%)。吸烟(62.2%)是主要危险因素,其次是高血压、糖尿病和高脂血症。大多数患者预后良好(92.7%)。轻微并发症(7.3%)包括血清肿形成和伤口感染,通过保守治疗处理。30%的患者采用自体静脉移植进行修复,70%的患者采用合成聚四氟乙烯(PTFE)移植。颈动脉支架置入术是最常见的血管内操作(n = 5)。股腘旁路移植术是最常见的手术,其次是颈动脉内膜切除术(n = 20)和主动脉股动脉旁路术(n = 14)。
结论 布加综合征中腔房分流等新技术的应用引起了人们对血管外科手术范围扩大的关注,颈动脉内膜切除术传统方法的改进凸显了血管血运重建的发展。我们的研究因此强调,从颈动脉狭窄到广泛的膝下疾病,无论是动脉粥样硬化性还是动脉瘤性的各种血管病变,都可以通过手术血运重建技术成功治疗。