Passman M A, Farber M A, Criado E, Marston W A, Burnham S J, Keagy B A
Division of Vascular Surgery, Department of Surgery, University of North Carolina, USA.
J Vasc Surg. 1999 Feb;29(2):249-58. doi: 10.1016/s0741-5214(99)70378-2.
Bypass grafts that originate from the descending thoracic aorta to the iliac or femoral arteries are well described but are not commonly used as primary procedures, and the long-term results remain unknown. A 15-year experience with 50 descending thoracic aorta to iliofemoral artery bypass grafts for aortoiliac occlusive disease is the basis of this report.
From January 1983 to December 1997, patients who underwent bypass grafting procedures from the descending thoracic aorta to the iliac or femoral arteries were identified. Surgical indications, morbidity and mortality rates, primary and secondary patency rates, limb salvage rates, and survival rates were determined.
Fifty descending thoracic aorta to iliofemoral artery bypass grafting procedures were performed 24 (48%) for severe claudication, 22 (44%) for rest pain, and 4 (8%) for ischemic ulceration. A primary procedure was performed in 31 patients (62%) for complete occlusion (21 patients) and severe atherosclerotic disease (10 patients) of the infrarenal aorta. The indications for 19 secondary revascularizations (38%) were prior aortic or extra-anatomic graft failure in 17 cases and aortic graft infection in 2 cases. The follow-up periods ranged from 1 to 150 months (mean, 39 months). The cumulative life-table 5-year primary patency, secondary patency, limb salvage, and survival rates were 79%, 84%, 93%, and 67%, respectively. An improved patency trend was observed for patients who underwent operation for severe claudication as compared with limb-threatening ischemia (92% and 69%; P =.07). However, there was no difference between primary and secondary operations in primary patency rates (81% and 79%; P = NS) or survival rates (72% and 62%; P = NS).
Descending thoracic aorta to iliofemoral artery bypass grafting has excellent overall long-term results. These results support its more liberal use for primary revascularization, especially for patients with severe atherosclerotic disease or complete occlusion of the infrarenal aorta.
起源于胸降主动脉至髂动脉或股动脉的旁路移植术已有详尽描述，但并不常用作主要术式，其长期效果仍不明确。本文报告基于50例胸降主动脉至髂股动脉旁路移植术治疗主髂动脉闭塞性疾病的15年经验。
确定1983年1月至1997年12月期间接受胸降主动脉至髂动脉或股动脉旁路移植术的患者。确定手术指征、发病率和死亡率、一期和二期通畅率、肢体挽救率和生存率。
共进行了50例胸降主动脉至髂股动脉旁路移植术，其中24例（48%）用于严重间歇性跛行，22例（44%）用于静息痛，4例（8%）用于缺血性溃疡。31例患者（62%）进行了一期手术，原因是肾下腹主动脉完全闭塞（21例）和严重动脉粥样硬化疾病（10例）。19例二期血管重建术（38%）的指征为17例先前主动脉或解剖外移植失败和2例主动脉移植感染。随访时间为1至150个月（平均39个月）。累积生命表5年一期通畅率、二期通畅率、肢体挽救率和生存率分别为79%、84%、93%和67%。与肢体威胁性缺血患者相比，因严重间歇性跛行接受手术的患者观察到通畅趋势改善（92%和69%；P = 0.07）。然而，一期手术和二期手术在一期通畅率（81%和79%；P = 无显著性差异）或生存率（72%和62%；P = 无显著性差异）方面没有差异。
胸降主动脉至髂股动脉旁路移植术具有出色的总体长期效果。这些结果支持更广泛地将其用于一期血管重建，特别是对于患有严重动脉粥样硬化疾病或肾下腹主动脉完全闭塞的患者。
