Marin M L, Veith F J, Sanchez L A, Cynamon J, Suggs W D, Schwartz M L, Parsons R E, Bakal C W, Lyon R T
Department of Surgery, Montefiore Medical Center, University Hospital for the Albert Einstein College of Medicine, New York, NY 10467, USA.
J Vasc Surg. 1995 Sep;22(3):316-24; discussion 324-5. doi: 10.1016/s0741-5214(95)70147-8.
Occlusive disease of the aortoiliac segment may lead to limb-threatening ischemia, if coexisting disease is present in the femoral, popliteal, or tibial arteries. The combined treatment of severe aortoiliac and infrainguinal disease with standard techniques may be hazardous or contraindicated in patients with multiple previous reconstructions, severe comorbid medical illnesses, or both. This report summarizes the technical feasibility and early results of aortoiliac endovascular stented grafts (ESGs) in combination with conventional surgical reconstructions for the treatment of multilevel arterial occlusive disease.
Seventeen patients with multilevel aortoiliofemoral limb-threatening occlusive disease had an ESG inserted to treat long-segment occlusive disease followed by a conventional surgical bypass. ESGs originated from the aortoiliac junction (seven) or the common iliac artery (10) and were inserted into the common femoral (nine), superficial femoral (four), or deep femoral (four) artery. ESG lengths ranged from 16 to 30 cm (mean, 21 cm). Conventional surgical bypasses were constructed from polytetrafluoroethylene (15) or saphenous vein (two) and extended to the popliteal (12), tibial (two), or contralateral femoral (three) arteries.
Technical success in graft insertion was achieved in 17 (94%) of 18 attempted ESG procedures. The 1-year primary and secondary cumulative patency rates for ESGs were 94% +/- 10% and 100%, respectively, whereas the 1- and 2-year patency rates for the extravascular grafts were 92% +/- 10% and 100%, respectively. Four patients had minor postprocedure complications (23%), and no deaths occurred. One patient lost his limb at 16 months because of severe pedal sepsis.
Transluminally placed stented grafts in combination with conventional surgical infrainguinal bypasses are a technically feasible and potentially safe option for the treatment of limb-threatening aortoiliofemoral occlusive disease and have demonstrated encouraging early patency. Long-term follow-up will be necessary before widespread application of this technique is advocated.
如果股动脉、腘动脉或胫动脉存在合并疾病，主髂动脉段闭塞性疾病可能导致肢体威胁性缺血。对于有多次既往重建手术史、严重合并内科疾病或两者兼有的患者，采用标准技术联合治疗严重的主髂动脉和腹股沟下疾病可能具有危险性或为禁忌。本报告总结了主髂动脉血管内支架移植物（ESG）联合传统外科重建术治疗多节段动脉闭塞性疾病的技术可行性和早期结果。
17例患有多节段主髂股肢体威胁性闭塞性疾病的患者植入ESG以治疗长段闭塞性疾病，随后进行传统外科旁路手术。ESG起源于主髂动脉交界处（7例）或髂总动脉（10例），并被植入股总动脉（9例）、股浅动脉（4例）或股深动脉（4例）。ESG长度为16至30厘米（平均21厘米）。传统外科旁路手术采用聚四氟乙烯（15例）或大隐静脉（2例）构建，并延伸至腘动脉（12例）胫动脉（2例）或对侧股动脉（3例）。
18例尝试的ESG手术中有17例（94%）成功植入移植物。ESG的1年原发性和继发性累积通畅率分别为94%±10%和100%，而血管外移植物的1年和2年通畅率分别为92%±10%和100%。4例患者出现轻微术后并发症（23%），无死亡病例。1例患者在16个月时因严重足部脓毒症而截肢。
经皮腔内放置支架移植物联合传统外科腹股沟下旁路手术是治疗肢体威胁性主髂股闭塞性疾病的一种技术可行且潜在安全的选择，并已显示出令人鼓舞的早期通畅率。在提倡广泛应用该技术之前，有必要进行长期随访。
