Leather R P, Shah D, Goldman M, Rosenberg M, Karmody A M
Arch Surg. 1979 Dec;114(12):1402-8. doi: 10.1001/archsurg.1979.01370360056006.
In good-risk patients, abdominal aortic aneurysmectomy can be accomplished with a mortality of 2% to 5%. However, in poor-risk patients, ie, those with severe reduction of cardiac, respiratory, and/or renal function, the mortality of this procedure has been reported to be as high as 60%. Fifteen poor-risk patients with abdominal aortic aneurysms have been treated with acute, induced thrombosis and simultaneous axillobilateral femoral bypass. Each patient had preoperative ultrasound and radionucleide flow studies and the runoff from the aneurysm was determined angiographically. Thrombosis, induced by interruption of the iliac outflow vessels, occurred in 12 patients within 72 hours. Flow persisted in three patients, and thrombosis was induced by transaxillary catheter deposition of bucrylate in the residual outflow vessels. There were two operative deaths (less than 30 days), both due to myocardial infarctions, and four late deaths, three of which were caused by the problems that initially contraindicated direct graft replacement of the aneurysm. Preliminary experience with this approach indicates that this is a simple and potentially effective method of treatment of abdominal aortic aneurysm where direct graft replacement is contraindicated.
在低风险患者中，腹主动脉瘤切除术的死亡率为2%至5%。然而，在高风险患者中，即心脏、呼吸和/或肾功能严重减退的患者，据报道该手术的死亡率高达60%。15例患有腹主动脉瘤的高风险患者接受了急性诱导血栓形成并同时进行腋双侧股动脉搭桥术。每位患者术前均进行了超声和放射性核素血流研究，并通过血管造影确定动脉瘤的血流情况。通过中断髂动脉流出血管诱导血栓形成，12例患者在72小时内发生血栓。3例患者血流持续存在，通过经腋导管在残余流出血管中注入丁酯来诱导血栓形成。有2例手术死亡（术后不到30天），均因心肌梗死，4例晚期死亡，其中3例是由最初禁忌直接进行动脉瘤移植置换的问题导致的。这种方法的初步经验表明，在禁忌直接进行动脉瘤移植置换的情况下，这是一种简单且可能有效的腹主动脉瘤治疗方法。
