Lynch K, Kohler T, Johansen K
J Vasc Surg. 1986 Nov;4(5):469-72. doi: 10.1067/mva.1986.avs0040469.
We reviewed the experience of 120 vascular surgeons with nonresective therapy for abdominal aortic aneurysm (AAA) in medically unstable patients. Of a total pool of 206 patients, 88 underwent iliac artery ligation, which was combined with angiographic attempts at intrasaccular thrombosis in 80% of cases. The remaining 118 patients had ligation of the aneurysm proximally and distally. In all cases distal perfusion was restored, usually by axillofemoral bypass. Our study demonstrated a significantly higher risk of postoperative AAA rupture (20% vs. 3.3%, p less than 0.0001) and death (34% vs. 5.1%, p less than 0.000001) among patients treated by ligation distal to the AAA alone, whether intrasaccular thrombosis occurred or not. These results support the contention that if nonresective therapy is chosen for the occasional patient deemed too ill to undergo standard AAA resection, AAA exclusion by proximal and distal ligation should be performed.
我们回顾了120位血管外科医生对病情不稳定的腹主动脉瘤（AAA）患者进行非切除治疗的经验。在总共206例患者中，88例行髂动脉结扎术，其中80%的病例在术中尝试进行瘤内血栓形成的血管造影。其余118例患者在动脉瘤的近端和远端进行结扎。在所有病例中，通常通过腋股旁路恢复远端灌注。我们的研究表明，无论是否发生瘤内血栓形成，单纯在AAA远端进行结扎治疗的患者术后AAA破裂风险（20%对3.3%，p<0.0001）和死亡风险（34%对5.1%，p<0.000001）显著更高。这些结果支持以下观点：如果为偶尔被认为病情过重而无法接受标准AAA切除术的患者选择非切除治疗，应进行近端和远端结扎以排除AAA。
