Amanvermez Senarslan Dilsad, Yildırım Funda, Bayram Barıs, Kurdal Adnan Taner, Tetik Omer
Department of Cardiovascular Surgery, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey.
SAGE Open Med. 2023 Sep 4;11:20503121231179836. doi: 10.1177/20503121231179836. eCollection 2023.
The current study aims to report midterm results of patients treated with endovascular intervention, kissing stent, or covered endovascular reconstruction of the aortic bifurcation, for Trans-Atlantic Inter-Society Consensus C or D aortoiliac occlusive disease involving the aortic bifurcation.
Eighteen patients who have intermittent claudication or chronic limb threatening ischemia with Trans-Atlantic Inter-Society Consensus C or D aortoiliac occlusive disease involving the aortic bifurcation enrolled to the study between January 2018 and January 2021. Kissing stents, Advanta V12 (Atrium, Getinge Group), were used in 13 patients, and the covered endovascular reconstruction of the aortic bifurcation technique was used in 4 patients to reconstruct the aortic bifurcation. The patients were followed for a median of 49 months (min. 2, max.58 months). Patency rates, mortality, morbidities, and reinterventions were recorded.
The mean age of the patients was 60.4 ± 10 years. Technical success was achieved in 94.4% of the patients, but one patient had to convert to open surgery. Primary patency rate of the remaining patients was 85.6% at 58 months. Target lesion revascularization rate was 11.7%. One patient had successful reintervention for in stent restenosis, and secondary patency rate was 93.3% at 58 months. Limb salvage rate was 84.6% during the follow-up. Two patients had myocardial infarction (11.1%) and one mortality (5.6%) occurred because of cerebrovascular event in the follow-up.
Endovascular techniques can be used safely for reconstruction of the aortic bifurcation in Trans-Atlantic Inter-Society Consensus C or D aortoiliac occlusive disease in selected patients who have high risk for open surgery. Covered endovascular reconstruction of the aortic bifurcation is the only technique that showed patency rates approaching open surgery in treatment of aortoiliac occlusive disease involving the aortic bifurcation to date. Although promising patency results were achieved with kissing-covered stents, long-term patency rates were still lower than those achieved with open surgery. Further randomized controlled studies comparing the long-term results of these techniques are needed.
本研究旨在报告接受血管内介入治疗、吻合法支架置入术或主动脉分叉覆膜血管内重建术治疗的患者的中期结果，这些患者患有跨大西洋两岸血管外科学会（Trans-Atlantic Inter-Society Consensus，TASC）C或D级累及主动脉分叉的主髂动脉闭塞性疾病。
2018年1月至2021年1月期间，18例患有间歇性跛行或慢性肢体威胁性缺血且患有TASC C或D级累及主动脉分叉的主髂动脉闭塞性疾病的患者纳入本研究。13例患者使用了吻合法支架Advanta V12（阿特rium公司，洁定集团），4例患者采用主动脉分叉覆膜血管内重建技术重建主动脉分叉。对患者进行了中位时间为49个月（最短2个月，最长58个月）的随访。记录通畅率、死亡率、发病率和再次干预情况。
患者的平均年龄为60.4±10岁。94.4%的患者手术成功，但有1例患者不得不转为开放手术。其余患者在58个月时的一期通畅率为85.6%。靶病变血运重建率为11.7%。1例患者因支架内再狭窄成功进行了再次干预，58个月时的二期通畅率为93.3%。随访期间肢体挽救率为84.6%。随访期间有2例患者发生心肌梗死（11.1%），1例患者因脑血管事件死亡（5.6%）。
对于开放手术风险高的特定患者，血管内技术可安全用于重建TASC C或D级主髂动脉闭塞性疾病的主动脉分叉。迄今为止，主动脉分叉覆膜血管内重建术是唯一一种在治疗累及主动脉分叉的主髂动脉闭塞性疾病时显示通畅率接近开放手术的技术。尽管吻合法覆膜支架取得了有前景的通畅结果，但长期通畅率仍低于开放手术。需要进一步进行随机对照研究以比较这些技术的长期结果。
