Miyata T, Sato O, Deguchi J, Kimura H, Namba T, Kondo K, Makuuchi M, Hamada C, Takagi A, Tada Y
Second Department of Surgery, Faculty of Medicine, The University of Tokyo, Japan.
J Vasc Surg. 1998 Mar;27(3):438-45. doi: 10.1016/s0741-5214(98)70318-0.
To evaluate the clinical characteristics of anastomotic aneurysms that develop in surgically treated patients with Takayasu's arteritis.
Among 103 patients with Takayasu's arteritis treated surgically over 40 years, 91 patients with 259 anastomoses (allowing for exclusion of 12 operative deaths) participated in follow-up study from 1 month to 37.3 years with a mean value +/- SEM of 17.3 +/- 1.1 years with a follow-up completion rate of 93% at 30 years. The clinical characteristics of anastomotic aneurysms were clarified, and the influences of several factors (sites of anastomoses, occlusive or aneurysmal disease, suture material, preoperative systemic inflammation, and administration of corticosteroids) on formation of anastomotic aneurysms were analyzed by means of life-table method and Cox regression analysis.
Twenty-two uninfected anastomotic aneurysms were found among 14 patients (22 of 259 anastomoses, 8.5%). The interval between the previous operation and diagnosis varied from 1.6 to 30 years with a mean value +/- SEM of 9.8 +/- 1.8 years. The cumulative incidence of anastomotic aneurysm at 20 years was 12.0%. Systemic inflammation or steroid administration had little influence on formation of anastomotic aneurysm. Instead, anastomotic aneurysm tended to occur after operations for aneurysmal lesions.
Anastomotic aneurysm can occur anytime after operations for Takayasu's arteritis. The development of anastomotic aneurysm is not influenced by any factor specific to this disease except the presence of an aneurysmal lesion.
评估在接受手术治疗的大动脉炎患者中发生的吻合口动脉瘤的临床特征。
在40年间接受手术治疗的103例大动脉炎患者中，91例有259处吻合口（排除12例手术死亡病例）参与了随访研究，随访时间从1个月至37.3年，平均值±标准误为17.3±1.1年，30年时随访完成率为93%。明确了吻合口动脉瘤的临床特征，并通过生命表法和Cox回归分析，分析了几个因素（吻合口部位、闭塞性或动脉瘤性疾病、缝合材料、术前全身炎症以及皮质类固醇的使用）对吻合口动脉瘤形成的影响。
在14例患者中发现了22处未感染的吻合口动脉瘤（259处吻合口中的22处，8.5%）。上次手术至诊断的间隔时间为1.6至30年，平均值±标准误为9.8±1.8年。20年时吻合口动脉瘤的累积发生率为12.0%。全身炎症或类固醇的使用对吻合口动脉瘤的形成影响不大。相反，吻合口动脉瘤倾向于在动脉瘤性病变手术后发生。
大动脉炎手术后任何时候都可能发生吻合口动脉瘤。除了存在动脉瘤性病变外，吻合口动脉瘤的发生不受该病任何特定因素的影响。
