耐力运动员髂动脉延长后的手术缩短：短期和长期满意度

Surgical shortening of lengthened iliac arteries in endurance athletes: Short-term and long-term satisfaction.

作者信息

van Hooff Martijn, Frenken Deafvon, Bender Mart, Loos Maarten, Brini Alberto, Savelberg Hans, Schep Goof, Scheltinga Marc R

机构信息

Department of Sports and Exercise, Máxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands; Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, Maastricht University Maastricht, Maastricht, Limburg, The Netherlands.

Department of Sports and Exercise, Máxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands.

出版信息

J Vasc Surg. 2023 Feb;77(2):588-598.e3. doi: 10.1016/j.jvs.2022.10.001. Epub 2022 Nov 9.

DOI:10.1016/j.jvs.2022.10.001

PMID:36334847

Abstract

OBJECTIVE

Endurance athletes are prone to develop flow limitations in iliac arteries (FLIA). Especially in cyclists and ice speed skaters, excessive hemodynamic loading coupled with hip hyperflexion may cause kinking in lengthened iliac arteries necessitating surgical correction. This study investigated the short-term (≤1.5 years) and long-term (≥5 years) satisfaction of operative shortening of the iliac artery in endurance athletes.

METHODS

All patients who were diagnosed and operated for FLIA owing to lengthened and kinked iliac arteries between 1997 and 2015 in one center were analyzed. Short-term follow-up consisted of an incremental maximal cycling test, ankle-brachial index with flexed hips, echo-Doppler examination with peak systolic velocity measurements and contrast-enhanced magnetic resonance angiography before and 6 to 18 months after surgery. Both short- and long-term satisfaction were assessed using questionnaires.

RESULTS

A total of 83 patients (90 operated legs; 96.7% males; median age of 34 years at the time of surgery; interquartile range [IQR], 29-47) were analyzed. In the short-term, 87.5% reported symptom reduction with an 86.4% overall satisfaction rate. Symptom-free cycling improved from 272 ± 84 W to 384 ± 101 W (P < .001), whereas the maximal workload increased from 419 ± 72 W to 428 ± 67 W (P = .01). The ankle-brachial index with flexed hips increased from 0.55 (IQR, 0.45-0.65) to 0.62 (IQR, 0.52-0.74; P = .008), and the peak systolic velocity measured with hips flexed decreased from 2.50 m/s (IQR, 1.77-3.13 m/s) to 1.57 m/s (IQR, 1.20-2.04 m/s; P < .001). After a median of 12 years (IQR, 9.0-15.4 years), symptoms were still decreased in 84.1% of patients with an 81.2% overall satisfaction rate (79.5% response rate). Three patients needed a reintervention (recurrent FLIA, n = 2; failure, n = 1).

CONCLUSIONS

Operative shortening of a lengthened and kinked iliac artery causing FLIA is successful both in the short- and long-term.

摘要

目的

耐力运动员容易出现髂动脉血流受限（FLIA）。特别是在自行车运动员和速度滑冰运动员中，过度的血流动力学负荷加上髋关节过度屈曲可能导致延长的髂动脉扭结，需要手术矫正。本研究调查了耐力运动员髂动脉手术缩短的短期（≤1.5年）和长期（≥5年）满意度。

方法

分析了1997年至2015年在一个中心因髂动脉延长和扭结而被诊断并接受FLIA手术的所有患者。短期随访包括递增最大骑行测试、髋关节屈曲时的踝臂指数、收缩期峰值速度测量的超声多普勒检查以及手术前和手术后6至18个月的对比增强磁共振血管造影。短期和长期满意度均使用问卷进行评估。

结果

共分析了83例患者（90条手术腿；男性占96.7%；手术时的中位年龄为34岁；四分位间距[IQR]为29 - 47）。短期内，87.5%的患者报告症状减轻，总体满意率为86.4%。无症状骑行功率从272±84瓦提高到384±101瓦（P <.001），而最大工作量从419±72瓦增加到428±67瓦（P =.01）。髋关节屈曲时的踝臂指数从0.55（IQR，0.45 - 0.65）增加到0.62（IQR，0.52 - 0.74；P =.008），髋关节屈曲时测量的收缩期峰值速度从2.50米/秒（IQR，1.77 - 3.13米/秒）降至1.57米/秒（IQR，1.20 - 2.04米/秒；P <.001）。中位随访12年（IQR，9.0 - 15.4年）后，84.1%的患者症状仍有减轻，总体满意率为81.2%（回复率79.5%）。3例患者需要再次干预（复发性FLIA，n = 2；手术失败，n = 1）。