腔内技术与主股动脉转流治疗TASCCD型主髂动脉病变的远期通畅率结果

Long term results of endovascular therapy and aortofemoral bypass for Transatlantic Inter-Society type C and D aortoiliac occlusive disease

目的:分析对比腔内技术与主股动脉转流治疗泛大西洋协作组(TASC)C D级主髂动脉病变的长期通畅率结果,为此类患者的手术选择提供依据。方法:回顾性分析安贞医院血管外科,2005年至2008年间,行腔内技术与主股动脉转流治疗TASC C D型主髂动脉病变77例(腔内治疗组35例,主股转流组42例),分析围手术期及远期预后,平均随访时间(59.7±18.7)个月。结果:腔内组5年一期通畅率68.8%,二期通畅率78.1%,总体生存率93.8%,总体保肢率90.6%;主股转流组5年一期通畅率92.1%,二期通畅率94.7%,总体生存率94.7%,总体保肢率97.3%。结论:腔内技术和主-股动脉转流治疗TASC C D型主髂动脉病变均可取得良好的远期疗效,但主-股动脉转流的远期通畅率更好。在无明显手术禁忌的情况下,应优先选择血管转流手术。

Objective：The purpose of this study was to compare the outcomes of endovascular therapy to those of aorto-femoral graft bypass for patients with Transatlantic Inter-Society Consensus（TASC Ⅱ） C and D aortoiliac occlusive disease,and to provide evidence for treatment choosing of this disease and experience for other multi-center randomize clinical trials.Methods： From 2005 to 2008,77 patients of TASC C and D aortoiliac occlusive disease underwent surgical and endovascular treatment in Anzhen hospital.35 patients underwent endonvascular therapy（group A） and 42 patients underwent aorto-femoral graft bypass（group B）.All clinical,perioperative and follow-up data at average（59.7±18.7） months were obtained.Results： 5 years primary and secondary patency are 68.8% and 78.1% for group A,92.1% and 94.7% for group B.The 5 years survival rate and limb salvage rate are 93.8% and 90.6% of group A,94.7% and 97.3% of group B.Conclusion： TASC C and D lesions can be treated with either endovascular therapy or aortofemoral graft bypass with satisfactory results.Compared with aortofemoral graft bypass,endovascular therapy is associated with decreased long term patency.Aortofemoral bypass should be the first choice for patients without contraindication of open surgery.