Cirafici L, Chapuis N, Merlini M
Département de chirurgie, Hôpital, La Chaux-de-Fonds.
Helv Chir Acta. 1993 Jun;59(5-6):829-33.
In chronic aortoiliac occlusive disease, 50 to 75% of the patients have further femoropopliteal lesions. The surgical treatment of these multilevel obstructions is sometimes controversial: the distal reconstruction can be performed at the time of the proximal one or deferred to a later date. It can be difficult to determine the hemodynamic importance of an iliac stenosis. Angiography is not a perfect predictor of the iliac segment hemodynamics because as it underestimates the severity of aorto-iliac stenoses when single plane views are taken. Direct measurement of the femoral pressure at angiography disclosing a gradient between brachial and femoral arteries indicates significant iliac stenosis. Intraarterial papaverine administration can also be of importance to determine critical stenoses. Despite proximal reconstruction, distal ischemia can persist if peripheral resistance is high. Distal revascularization can relieve ischemic symptoms, providing an adequate outflow bed. However some patients do not benefit from this two-level procedure because of a steal phenomenon in the intermediate vascular bed.
在慢性主-髂动脉闭塞性疾病中，50%至75%的患者存在进一步的股-腘动脉病变。这些多节段阻塞的外科治疗有时存在争议：远端重建可在近端重建时进行，也可推迟至以后。确定髂动脉狭窄对血流动力学的重要性可能很困难。血管造影并非髂动脉节段血流动力学的完美预测指标，因为在采用单平面视图时，它会低估主-髂动脉狭窄的严重程度。血管造影时直接测量股动脉压力，若显示肱动脉与股动脉之间存在压差，则提示髂动脉存在明显狭窄。动脉内注射罂粟碱对于确定严重狭窄也可能具有重要意义。尽管进行了近端重建，但如果外周阻力较高，远端缺血仍可能持续。远端血管重建可缓解缺血症状，前提是要有足够的流出道。然而，由于中间血管床存在盗血现象，一些患者无法从这种两级手术中获益。
