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...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。展开更多
Background： Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus （TASC） Ⅱ guideline, but endovascular solutions also appear to be a val...Background： Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus （TASC） Ⅱ guideline, but endovascular solutions also appear to be a valid option in selected patients. The study aimed to identify the risk factors ofrestenosis after open and endovascular reconstruction of symptomatic TASC Ⅱ D aortoiliac occlusive lesions （AIOLs）. Methods： Fifty-six patients （82 limbs） who underwent open repair and endovascular treatment （ET） for symptomatic TASC II D AlOEs between March 2005 and December 2012 were retrospectively reviewed. Baseline characteristics, preoperative and postoperative imaging, and operation procedure reports were reviewed and analyzed. Restenosis after revascularization was assessed by duplex ultrasound or computed tomography angiogram. Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression were used to evaluate the relevance between risk factors and patency. Results： The mean duration of follow-up was 42.8 ± 23.5 months （ranging from 3 to 90 months）. Primary patency rates at 1-, 3-, 5-, and 7-year were 93.6%, 89.3%, 87.0%, and 70.3%, respectively. Restenosis after revascularization occurred in 1 ） limbs. Kaplan-Meier survival analysis and the Log-rank test revealed that diabetes, Rutherford classification ≥5^th and concurrent femoropopliteal TASC Ⅱ type C/D lesions were significantly related to the duration of primary patency. According to the result of Cox regression, diabetes and femoropopliteal TASC Ⅱ type C/D lesions were identified as the risk factors for restenosis after revascularization. Conclusion： This study demonstrated that diabetes and femoropopliteal TASC Ⅱ type C/D lesions are risk factors associated with restenosis after open and ET of TASC Ⅱ D AlOEs.展开更多
文摘目的: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。
基金We appreciate the guidance and proof-reading of Prof. Miltiadis E Krokidis from Cambridge University Hospital.This study was supported by a grant from National Natural Science Foundation of China （No. 81370420）.
文摘Background： Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus （TASC） Ⅱ guideline, but endovascular solutions also appear to be a valid option in selected patients. The study aimed to identify the risk factors ofrestenosis after open and endovascular reconstruction of symptomatic TASC Ⅱ D aortoiliac occlusive lesions （AIOLs）. Methods： Fifty-six patients （82 limbs） who underwent open repair and endovascular treatment （ET） for symptomatic TASC II D AlOEs between March 2005 and December 2012 were retrospectively reviewed. Baseline characteristics, preoperative and postoperative imaging, and operation procedure reports were reviewed and analyzed. Restenosis after revascularization was assessed by duplex ultrasound or computed tomography angiogram. Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression were used to evaluate the relevance between risk factors and patency. Results： The mean duration of follow-up was 42.8 ± 23.5 months （ranging from 3 to 90 months）. Primary patency rates at 1-, 3-, 5-, and 7-year were 93.6%, 89.3%, 87.0%, and 70.3%, respectively. Restenosis after revascularization occurred in 1 ） limbs. Kaplan-Meier survival analysis and the Log-rank test revealed that diabetes, Rutherford classification ≥5^th and concurrent femoropopliteal TASC Ⅱ type C/D lesions were significantly related to the duration of primary patency. According to the result of Cox regression, diabetes and femoropopliteal TASC Ⅱ type C/D lesions were identified as the risk factors for restenosis after revascularization. Conclusion： This study demonstrated that diabetes and femoropopliteal TASC Ⅱ type C/D lesions are risk factors associated with restenosis after open and ET of TASC Ⅱ D AlOEs.
