Department of Sports and Exercise, Máxima Medical Centre, Veldhoven, the Netherlands; Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University Maastricht, Maastricht, the Netherlands.
Department of Sports and Exercise, Máxima Medical Centre, Veldhoven, the Netherlands; Royal Netherlands Army, Ministry of Defence, Hilversum, the Netherlands.
J Vasc Surg. 2023 Aug;78(2):514-524.e2. doi: 10.1016/j.jvs.2023.03.501. Epub 2023 Apr 14.
Endurance athletes such as cyclists may develop intermittent claudication owing to iliac artery endofibrosis after long-lasting extreme hemodynamic challenges. This study investigated short-term (<1.5 years) and long-term (>5 years) satisfaction and safety after a surgical endarterectomy and autologous patching.
Data of endurance athletes who underwent an endarterectomy for flow limitation of the iliac artery owing to endofibrosis between 1997 and 2015 in one center were studied. Maximal cycling exercise tests, ankle-brachial index with flexed hips, echo-Doppler examination (peak systolic velocity), and contrast-enhanced magnetic resonance angiography were performed before and 6 to 18 months after surgery. Short-term and long-term satisfaction were evaluated using questionnaires. Potential patch dilatation was assessed using echo-Doppler.
Analysis of 68 patients (79 legs; 55.7% males, median age at the time of surgery, 34 years; interquartile range, 26-41 years) demonstrated that cycling workload at symptom onset improved from 226 ± 97 to 333 ± 101 (P < .001) Watts. Peak workload increased from 326 ± 111 to 352 ± 93 Watts (P < .001). Ankle-brachial index with flexed hips increased from 0.34 (interquartile range [IQR], 0.00-0.47) to 0.59 (IQR, 0.51-0.69; P < .001). Peak systolic velocity with extended and flexed hip decreased from 2.04 m·sec (IQR, 1.52-2.56 m·3sec) to 1.25 m·sec (IQR, 0.92-1.62 m·sec; P < .001) and 2.40 m·sec (IQR, 1.81-2.81 m·sec) to 1.15 m·sec (IQR, 0.97-1.60 m·sec; P < .001), respectively. Thirty-day major complication rate was 5.1% (hematoma requiring evacuation n = 2, septic bleeding from deep infection n = 1, and iliac occlusion requiring thrombectomy n = 1). In the short term, 91.2% of patients reported symptom reduction with a 93.7% overall satisfaction rate. After a median of 11.1 years (IQR, 7.8-17.6 years), the overall satisfaction was 91.7%; 94.5% of patients reported persistent symptom reduction. Patch dilatation of >20 mm was observed in two patients. Linear mixed model analysis revealed no alarming patch dilatation in the long term.
Endarterectomy with an autologous patch for intermittent claudication owing to iliac artery endofibrosis in endurance athletes shows high rates of patient satisfaction and symptom reduction in both the short and long term. The risk of surgical complications or patch dilatation is mild. A surgical intervention for flow limitation of the iliac artery owing to endofibrosis is safe and successful.
由于髂动脉内膜纤维化，耐力运动员在长时间的极端血液动力学挑战后可能会出现间歇性跛行。本研究调查了在一个中心接受外科内膜切除术和自体补丁治疗后 1.5 年以内（<1.5 年）和 5 年以上（>5 年）的短期和长期满意度和安全性。
研究了 1997 年至 2015 年间因内膜纤维化导致髂动脉血流受限而接受内膜切除术的耐力运动员的数据。在手术前和术后 6 至 18 个月，进行最大踏车运动试验、髋部弯曲时的踝臂指数、超声多普勒检查（收缩期峰值速度）和对比增强磁共振血管造影。使用问卷调查评估短期和长期满意度。使用超声多普勒评估潜在的补丁扩张。
对 68 例患者（79 条腿；55.7%为男性，手术时的中位年龄为 34 岁；四分位间距 26-41 岁）的分析表明，症状发作时的踏车工作量从 226±97 增加到 333±101（P<.001）瓦特。峰值工作量从 326±111 增加到 352±93 瓦特（P<.001）。髋部弯曲时的踝臂指数从 0.34（四分位间距 [IQR]，0.00-0.47）增加到 0.59（IQR，0.51-0.69；P<.001）。伸展和弯曲髋关节时的收缩期峰值速度从 2.04 m·sec（IQR，1.52-2.56 m·3sec）降至 1.25 m·sec（IQR，0.92-1.62 m·sec；P<.001）和 2.40 m·sec（IQR，1.81-2.81 m·sec）至 1.15 m·sec（IQR，0.97-1.60 m·sec；P<.001）。30 天主要并发症发生率为 5.1%（血肿需引流 n=2，深部感染导致败血症出血 n=1，髂动脉闭塞需血栓切除术 n=1）。短期随访中，91.2%的患者报告症状减轻，总满意度为 93.7%。中位数随访 11.1 年（IQR，7.8-17.6 年）后，总满意度为 91.7%；94.5%的患者报告持续减轻症状。两名患者出现补丁扩张>20mm。线性混合模型分析显示，长期随访中无明显的补丁扩张。
对于因髂动脉内膜纤维化而导致间歇性跛行的耐力运动员，采用自体补丁的内膜切除术显示出短期和长期内均有较高的患者满意度和症状缓解率。手术并发症或补丁扩张的风险较轻。因内膜纤维化导致髂动脉血流受限的手术干预是安全且成功的。
