复杂TASC D级髂股动脉病变的杂交手术治疗

Hybrid surgery for complex TASC type D iliac and femoral occlusive disease

目的研究杂交手术治疗复杂泛大西洋学会共识(TASC)D级髂股动脉病变的安全性和中期效果。方法回顾性分析2007年1月至2013年12月青岛大学附属医院收治的复杂D级髂股动脉病变患者27例,根据CT血管成像(CTA)和TASC病变分级原则,C级主髂动脉病变合并D级股胭动脉病变14例,D级主髂动脉病变合并C级股腘动脉病变7例,D级主髂动脉病变合并D级股腘动脉病变6例;所有患者行杂交手术同期处理主髂和股腘动脉病变。记录患者术前、术后6、12、24和36个月的踝肱指数(ABI),并分析术前、术后12、24和36个月的通畅率。计量资料组间比较采用t检验,通畅率采用Kaplan-Meieir生存曲线分析。结果对于主髂动脉病变,术中分别或联合行主股动脉旁路、髂动脉支架植入、股股动脉旁路及内膜剥脱或取栓术;对于股胭动脉病变,术中分别或联合行股胭动脉旁路、动脉内膜剥脱、股深动脉成形、取栓、球囊扩张及支架植入。围手术期无死亡及大并发症发生。术后6、12、24和36个月的患者ABI(0.91±0.16、0.85±0.14、0.82±0.17、0.77±0.13)比术前(0.47±0.4)显著升高,差异有统计学意义(P<0.01)。术后12、24和36个月通畅率分别为95.7%、80.2%和72.9%。结论杂交手术治疗复杂TASC D级髂股动脉病变安全,中期效果好,尤其适合于高龄、高危患者。

Objective To determine the safety and midterm efficacy of hybrid surgery for complex Trans-Atlantic Inter-Society Consensus （TASC） type D iliac and femoral occlusive lesions. Methods Twenty-seven patients with complex type D iliac and femoral lesions admitted in our department from January 2007 to December 2013 were recruited in this study. According to the results of com-puted tomography angiography （CTA） and TASC recommendation, the patients were assigned into groups of aorto-iliac C type plus femoropopliteal D type segment lesions （n=14）,aorto-iliac D type plus femoro-popliteal C type segment lesions （n=7）, and aorto-iliac D type plus femoro-popliteal D type segment lesions（n=6）,and all of them underwent hybrid surgery for aorto-iliac and femoro-popliteal lesions simultaneously to improve the inflow and outflow. Ankle-brankial index （ABI） before and in 6, 12, 24, and 36 months after surgery,and preoperative and postoperative patency rates （12,24, and 36 months） were recorded and analyzed. SPSS statistics 16.0 was used to perform the statistical analysis. Student＇s t test was employed in intergroup comparison for measurement data. Kaplan-Meier survival analysis was adopted to analyze the patency rate. Results For aorto-iliac lesions, aorto-femoral artery bypass,iliac artery stenting,crossover femoro-femoral bypass,and endarterectomy or thrombectomy were performed respectively or in combination. For femoro-popliteal lesions, femoro-popliteal bypass, endarterectomy, femoral profundaplasty, thrombectomy, balloon dilatation and stent implantation were chosen respectively or in combination. No peri-operative death or major complications was observed. ABI was significantly increased in 6, 12, 24, and 36 months after surgery （0.91±0.16, 0.85±0.14, 0.82±0.17, 0.77±0.13 vs 0.47±0.24,P〈0.01）. The patency rate was 95.7%,80.2% and 72.9% respectively in 12,24, and 36 months postoperatively. Conclusion Hybrid surgery is safe and has good midterm outcomes for the patients with complex type D iliac and femoral lesions,especially for high-risk older patients.