Dougherty M J, Hallett J W, Naessens J, Bower T C, Cherry K J, Gloviczki P, Pairolero P C
Division of Vascular Surgery, Mayo Clinic and Foundation, Rochester, Minn. 55905, USA.
Ann Vasc Surg. 1995 Jan;9(1):87-94. doi: 10.1007/BF02015321.
Are there differences in the patient characteristics and clinical outcome for transaortic renal endarterectomy vs. bypass grafting when either technique is combined with infrarenal aortic replacement for occlusive or aneurysmal disease? Two common perceptions persist: (1) combined aortic and renal procedures have a high risk and (2) bypass is easier and safer than endarterectomy. To address these controversies we compared 52 consecutive patients undergoing concomitant aortic and renal reconstruction between 1987 and 1991: 26 with bypass and 26 with endarterectomy. Bypass patients were older (70 vs. 64 years, p = 0.001), had more extensive plaque extending into the distal renal artery and more severe baseline azotemia (creatinine = 2.6 vs 1.7 mg/dl, p = 0.01), more clinically evident coronary heart disease (89% vs. 56%, p = 0.001), and a greater need for nephrectomy of a small nonfunctional pressor kidney (23% vs. 0%) than endarterectomy patients. In contrast, endarterectomy patients more commonly required aortic replacement for occlusive disease than for an aortic aneurysm (endarterectomy: 65% vs. 35%; bypass: 19% vs 81%, p = 0.002) and tended to require more intraoperative technical revisions (12% vs. 4%) than bypass patients. Both groups, however, experienced no operative mortality, had similar cardiorespiratory morbidity, and achieved equal improvement in hypertension (69% vs. 65%). Bypass patients, who already had more severe preoperative azotemia than endarterectomy patients, showed less improvement in the creatinine level (Cr = 2.1 vs. 1.4 mg/dl, p = 0.01) and had greater need for late dialysis (30% vs. 4%, p = 0.01). Only one patient on dialysis had graft occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)
当经主动脉肾动脉内膜切除术和旁路移植术这两种技术与肾下主动脉置换术联合用于治疗闭塞性或动脉瘤性疾病时，患者特征和临床结果是否存在差异？两种普遍的观点依然存在：（1）主动脉和肾脏联合手术风险高；（2）旁路移植术比内膜切除术更容易、更安全。为解决这些争议，我们比较了1987年至1991年间连续接受主动脉和肾脏联合重建手术的52例患者：26例行旁路移植术，26例行内膜切除术。行旁路移植术的患者年龄更大（70岁对64岁，p = 0.001），延伸至肾动脉远端的斑块更广泛，基线氮质血症更严重（肌酐= 2.6对1.7mg/dl，p = 0.01），临床上明显的冠心病更多（89%对56%，p = 0.001），并且与行内膜切除术的患者相比，因小的无功能加压肾而需要肾切除术的需求更大（23%对0%）。相比之下，行内膜切除术的患者因闭塞性疾病而非主动脉瘤需要进行主动脉置换术的情况更常见（内膜切除术：65%对35%；旁路移植术：19%对81%，p = 0.002），并且与行旁路移植术的患者相比，往往需要更多的术中技术修正（12%对4%）。然而，两组患者均无手术死亡，心肺发病率相似，高血压改善程度相同（69%对65%）。术前氮质血症比行内膜切除术的患者更严重的行旁路移植术的患者，肌酐水平改善较少（Cr = 2.1对1.4mg/dl，p = 0.01），并且后期透析需求更大（30%对4%，p = 0.01）。只有1例透析患者出现移植物闭塞。（摘要截短至250字）
