Lorenzi G, Domanin M, Costantini A, Rolli A, Agrifoglio G
Institute of Vascular Surgery and Angiology, University of Milan, Italy.
Cardiovasc Surg. 1994 Jun;2(3):370-3.
Some 1257 patients who had undergone revascularization procedures for unilateral iliac occlusions were reviewed retrospectively. A total of 824 patients were operated upon using conventional operations, 165 patients had femorofemoral bypass and 268 were treated using endovascular surgery techniques. Revascularization was performed through an extraperitoneal approach by means of iliac thromboendarterectomy (560) or iliac femoral bypass (264) if there was a total occlusion of either the common or external iliac artery (group 1). A femorofemoral crossover bypass was inserted when the operative risk was considered to be high (group 2). Endovascular procedures (percutaneous transluminal angioplasty 234, laser percutaneous transluminal angioplasty 11, stenting 22, atherectomy one) were used in recent years to treat stenoses or occlusions of 3 cm or less (group 3). The indications for operation were severe claudication in 79.7% in group 1 and 92.6% in group 3, whereas in group 2 66.7% of patients presented with symptoms of more advanced ischaemia. The immediate patency rate was 97.0% after extraperitoneal reconstructive surgery, 96.9% in the femorofemoral group and 92.1% in patients having an endovascular procedure. The operative mortality rate was 0.7, 4.2, and 0.3% for groups 1-3, respectively. The 5-year patency rate, analysed by the life-table method, was 77.9% in group 1, 75.3% in group 2 and 73.7% in group 3 (P = n.s., log rank test). The different revascularization techniques were chosen on the basis of the type of disease present and the patient's general condition. All procedures appeared to be effective when correctly selected.
对1257例因单侧髂动脉闭塞而接受血管重建手术的患者进行了回顾性研究。其中824例患者接受了传统手术，165例患者进行了股股动脉搭桥术，268例患者采用血管腔内手术技术治疗。如果髂总动脉或髂外动脉完全闭塞（第1组），则通过腹膜外途径，采用髂动脉血栓内膜切除术（560例）或髂股动脉搭桥术（264例）进行血管重建。当手术风险被认为较高时，采用股股交叉搭桥术（第2组）。近年来，血管腔内手术（经皮腔内血管成形术234例、激光经皮腔内血管成形术11例、支架置入术22例、旋切术1例）用于治疗3厘米及以下的狭窄或闭塞（第3组）。第1组手术指征为严重间歇性跛行的患者占79.7%，第3组为92.6%，而第2组66.7%的患者表现为更严重的缺血症状。腹膜外重建手术后即刻通畅率为97.0%，股股动脉组为96.9%，血管腔内手术患者为92.1%。第1 - 3组的手术死亡率分别为0.7%、4.2%和0.3%。采用寿命表法分析，第1组5年通畅率为77.9%，第2组为75.3%，第3组为73.7%（P = 无统计学意义，对数秩检验）。根据所患疾病类型和患者一般情况选择不同的血管重建技术。所有手术方法在正确选择时似乎都是有效的。
