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Abstract：
OBJECTIVE. The purpose of this study is to compare the clinical and safety outcomes between two groups of patients with Trans-Atlantic Inter-Society Consensus class D (TASC II D) aortoiliac occlusive disease (AIOD): those with higher-risk comorbidity who underwent endovascular reconstruction and those with lower-risk comorbidity who underwent surgical bypass. MATERIALS AND METHODS. Thirty-two consecutive patients with symptomatic TASC II D AOID who underwent surgical bypass or endovascular reconstruction from 2012 to 2017 were retrospectively reviewed. Lesion characteristics, technical approach, survival, limb salvage, patency, and change in clinical symptoms were analyzed. RESULTS. Nineteen patients with higher comorbidity underwent endovascular reconstruction, whereas 13 patients with lower comorbidity underwent surgical bypass. Patients undergoing endovascular reconstruction had an older median age (67.0 vs 62.0 years; p = 0.007), higher rates of hypertension (94.7% vs 61.5%; p = 0.018) and coronary artery disease (26.3% vs 0%; p = 0.044), and advanced renal impairment (mean [± SD] chronic kidney disease stage, 1.4 ± 1.5 vs 0.7 ± 1.3; p = 0.005). There were no significant differences in Rutherford classification between the groups. During long-term follow-up of 2.76 years, endovascular reconstruction and surgical bypass showed equivalent rates of survival (89.5% vs 84.6%; p = 0.683), limb salvage (100.0% vs 92.3%; p = 0.219), and primary or primary-assisted patency (85% vs 85%; p = 0.98). Groups showed similar clinical improvements in walking distance, rest pain, and tissue loss at 30 days (95% vs 85%; p = 0.158) and at long-term follow-up (74% vs 62%; p = 0.599). CONCLUSION. For properly selected patients, the clinical outcomes of endovascular reconstruction versus surgical bypass for TASC II D AOID may be equivalent at 2.5 years after the procedure. The decreased operative risk associated with endovascular reconstruction suggests that it is the technique of choice for high-risk patients.
摘要：
目标。这项研究的目的是比较两组跨大西洋社会共识D类（TASCIID）主髂动脉闭塞性疾病（AIOD）患者的临床和安全性结果：高风险合并症患者接受血管内重建和低风险合并症患者接受手术搭桥。材料和方法。回顾性分析了2012年至2017年间32例连续有症状的TASCIIDAOID患者接受了手术旁路或血管内重建。病变特征,技术方法,生存,肢体抢救,通畅，并对临床症状的变化进行分析。结果。19例合并症较高的患者接受了血管内重建，而13例合并症较低的患者接受了手术旁路手术。接受血管内重建的患者中位年龄较大（67.0岁vs62.0岁；p=0.007），高血压(94.7%vs61.5%;p=0.018)和冠状动脉疾病(26.3%vs0%;p=0.044)的发生率更高，和晚期肾功能损害（平均[±SD]慢性肾病分期，1.4±1.5vs0.7±1.3；p=0.005）。两组之间的卢瑟福分类没有显着差异。在2.76年的长期随访中，血管内重建和手术旁路显示相同的生存率（89.5％vs84.6％；p=0.683），保肢（100.0%vs92.3%；p=0.219），和原发性或原发性辅助通畅（85％vs85％；p=0.98）。各组在步行距离方面表现出相似的临床改善，休息疼痛，30天（95％vs85％；p=0.158）和长期随访（74％vs62％；p=0.599）时的组织丢失。结论。对于正确选择的患者，TASCIIDAOID的血管内重建与手术搭桥术的临床结局在手术后2.5年时可能相当.与血管内重建相关的手术风险降低表明，这是高风险患者的首选技术。
