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[腹主动脉-股动脉旁路移植术后假性动脉瘤和移植物感染的发生风险。回顾性研究。211例报告]

[Risk of development of false aneurysm and graft infection after aorta-femoral bypass graft. Retrospective study. Report of 211 cases].

作者信息

Aguiar E T, Langer B, Lobato A C

机构信息

Service de Chirurgie Vasculaire de la Faculté de Médecine de l'Université de Sao Paulo, Brésil.

出版信息

J Mal Vasc. 1996;21(1):36-9.

PMID:8656089
Abstract

Anastomotic aneurysm and infection of arterial graft are complications that occur late after aorto-femoral bypass graft surgery. The objective of this paper is to calculate the percentage of patients free of these complications after 10 years. From 1966 to 1983, 211 patients were operated on consecutively to treat aortoiliac atherosclerotic obstructive disease. There were 173 (82%) men and 38 (18%) women of mean age 54.7 +/- 9.1 years. Forty-one percent of patients were operated on for limb salvage. Aorto-bi-femoral bypass was performed in 196 (92.9%) patients; the unilateral aorto-femoral bypass in 8 (3.8%) and the aorto-femoral to one side and aorto-iliac to the order in 7 (3.3%). In 28 patients, the bypass was associated with femoro-popliteal bypass (21 patients) or reconstruction of visceral arteries (7 patients). The anastomosis was end-to-side both in the aorta and in the femoral arteries, made of synthetic sutures. Diagnosis of the complications was made by physical examination, ultrasonography, CT scan or arteriography. The Kaplan-Meier method was used to determine the percentage of patients without complications. After 24, 60 and 120 months, 98.5%, 92.6% and 85.4% of the patients were free of anastomotic aneurysm, respectively and after the same periods, 97.3%, 90.4% and 75.2% of the patients respectively were free of graft infection (table 2). We conclude that the risk of developing complications is a permanent risk and increases with time, but the use of grafts cannot be invalidated.

摘要

吻合口动脉瘤和动脉移植物感染是腹主动脉-股动脉旁路移植术后晚期出现的并发症。本文的目的是计算10年后无这些并发症的患者百分比。1966年至1983年,连续对211例患者进行手术治疗腹主动脉髂动脉粥样硬化性阻塞性疾病。其中男性173例(82%),女性38例(18%),平均年龄54.7±9.1岁。41%的患者手术目的是挽救肢体。196例(92.9%)患者行腹主动脉双股动脉旁路移植术;8例(3.8%)患者行单侧腹主动脉-股动脉旁路移植术,7例(3.3%)患者行一侧腹主动脉-股动脉旁路移植术及另一侧腹主动脉-髂动脉旁路移植术。28例患者的旁路移植术与股动脉-腘动脉旁路移植术(21例患者)或内脏动脉重建术(7例患者)相关。主动脉和股动脉的吻合均为端侧吻合,采用合成缝线。通过体格检查、超声、CT扫描或动脉造影对并发症进行诊断。采用Kaplan-Meier法确定无并发症患者的百分比。术后24个月、60个月和120个月,分别有98.5%、92.6%和85.4%的患者无吻合口动脉瘤,同期分别有97.3%、90.4%和75.2%的患者无移植物感染(表2)。我们得出结论,发生并发症的风险是一种长期风险,且随时间增加,但移植物的使用不能被否定。

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