Ohki T, Marin M L, Veith F J, Lyon R T, Sanchez L A, Suggs W D, Yuan J G, Wain R A, Parsons R E, Patel A, Rivers S P, Cynamon J, Bakal C W
Department of Surgery, Montefiore Medical Center, University Hospital, Albert Einstein College of Medicine, New York, NY 10467, USA.
J Vasc Surg. 1996 Dec;24(6):984-96; discussion 996-7. doi: 10.1016/s0741-5214(96)70044-7.
Although axillobifemoral bypass procedures have a lower mortality rate than aortobifemoral bypass procedures, they are limited by decreased patency, moderate hemodynamic improvement, and the need for general anesthesia. This report describes an alternative approach to bilateral aortoiliac occlusive disease using unilateral endovascular aortofemoral bypass procedures in combination with standard femorofemoral reconstructions.
Seven patients who had bilateral critical ischemia and tissue necrosis in association with severe comorbid medical illnesses underwent implantation of unilateral aortofemoral endovascular grafts, which were inserted into predilated, recanalized iliac arteries. The proximal end of the endovascular graft was fixed to the distal aorta or common iliac artery with a Palmaz stent. The distal end of the graft was suture-anastomosed to the ipsilateral patent outflow vessel, and a femorofemoral bypass procedure was then performed.
All endovascular grafts were successfully inserted through five occluded and two diffusely stenotic iliac arteries under either local (1), epidural (5), or general anesthesia (1). The mean thigh pulse volume recording amplitudes increased from 9 +/- 3 mm to 30 +/- 7 mm and from 6 +/- 2 mm to 26 +/- 4 mm ipsilateral and contralateral to the aortofemoral graft insertion, respectively. In all cases the symptoms completely resolved. Procedural complications were limited to one local wound hematoma. No graft thromboses occurred during follow-up to 28 months (mean, 17 months).
Endovascular iliac grafts in combination with standard femorofemoral bypass grafts may be an effective alternative to axillobifemoral bypass in high-risk patients who have diffuse aortoiliac occlusive disease, particularly when bilateral axillary-subclavian disease is present.
尽管腋股动脉搭桥手术的死亡率低于主股动脉搭桥手术，但它受到通畅率降低、血流动力学改善程度中等以及需要全身麻醉的限制。本报告描述了一种治疗双侧主髂动脉闭塞性疾病的替代方法，即采用单侧血管腔内主股动脉搭桥手术并结合标准的股股动脉重建术。
7例患有双侧严重缺血和组织坏死并伴有严重合并症的患者接受了单侧主股动脉血管腔内移植物植入术，该移植物被插入预先扩张、再通的髂动脉。血管腔内移植物的近端用帕尔马兹支架固定于远端主动脉或髂总动脉。移植物的远端通过缝合与同侧通畅的流出血管吻合，然后进行股股动脉搭桥手术。
所有血管腔内移植物均成功通过5条闭塞和2条弥漫性狭窄的髂动脉插入，麻醉方式为局部麻醉（1例）、硬膜外麻醉（5例）或全身麻醉（1例）。股动脉移植物插入侧和对侧大腿脉搏容积记录幅度的平均值分别从9±3mm增加到30±7mm和从6±2mm增加到26±4mm。所有病例症状均完全缓解。手术并发症仅限于1例局部伤口血肿。在长达28个月（平均17个月）的随访期间未发生移植物血栓形成。
对于患有弥漫性主髂动脉闭塞性疾病的高危患者，特别是存在双侧腋-锁骨下动脉疾病时，血管腔内髂动脉移植物与标准的股股动脉搭桥移植物相结合可能是腋股动脉搭桥的一种有效替代方法。
