Abstract：
OBJECTIVE: Aortic endarterectomy (AE), once a treatment of choice for aortoiliac occlusive disease, is now rarely performed in favor of endovascular procedures or open aortobifemoral bypass. However, in select patients with paravisceral or aortoiliac occlusive disease, AE remains a viable alternative for revascularization, either as a primary procedure or after prior interventions have failed. Here, we evaluated outcomes for an extended series of patients undergoing paravisceral or aortoiliac endarterectomy, demonstrating that these procedures can be an excellent alternative with acceptable morbidity and mortality in properly selected patients.
METHODS: A single institution retrospective review of 20 patients who underwent AE from 2017 to 2023 was performed.
RESULTS: Five patients (25%) underwent paravisceral endarterectomy and 15 (75%) underwent aortoiliac endarterectomy. There were no perioperative mortalities. One paravisceral patient died 3 months postoperatively from complications of pneumonia. Three patients in the paravisceral group required reinterventions; one acutely due to thrombosis of the superior mesenteric artery (SMA) requiring extension of the endarterectomy and patch angioplasty on postoperative day 0, one due to stenosis at the distal edge of the endarterectomy 1 month postoperatively, successfully treated with SMA stenting, and one at 10-month follow-up due to SMA stenosis at the distal aspect of the endarterectomy, also successfully treated with SMA stenting. With these reinterventions, the 1-year primary patency in the paravisceral group was 40%, primary-assisted patency was 80%, and secondary patency was 100%. In the aortoiliac group, 1-year primary, primary-assisted, and secondary patency were 91%, 91%, and 100%, respectively. One patient developed iliac thrombosis 10 days postoperatively owing to an intimal flap distal to the endarterectomy site. She and one other patient, a young man with an undefined hypercoagulable disorder, ultimately required neoaortoiliac reconstructions at 18 and 32 months postoperatively, respectively (the latter in the setting of stopping anticoagulation). The remaining 13 patients experienced no complications. All patients had rapid resolution of clinical symptoms, and median postoperative ankle-brachial indexes of 1.06 on the right and 1.00 on the left, representing a median improvement from preoperative ankle-brachial indexes of +0.59 on the right and +0.56 on the left (P < .01 and P < .01).
CONCLUSIONS: In this series of 20 patients undergoing paravisceral and infrarenal aortoiliac endarterectomy, AE was associated with no perioperative mortality, relatively low and manageable morbidity, and excellent clinical outcomes in patients with both paravisceral and aortoiliac occlusive disease. SMA-related early reintervention was not uncommon in the paravisceral group, and attention should be given particularly to the distal endarterectomy site. AE remains a viable treatment for severe multivessel paravisceral or aortoiliac occlusive disease isolated to the aorta and common iliac arteries in select patients.
METHODS: A single institution retrospective review of 20 patients who underwent AE from 2017 to 2023 was performed.
RESULTS: Five patients (25%) underwent paravisceral endarterectomy and 15 (75%) underwent aortoiliac endarterectomy. There were no perioperative mortalities. One paravisceral patient died 3 months postoperatively from complications of pneumonia. Three patients in the paravisceral group required reinterventions; one acutely due to thrombosis of the superior mesenteric artery (SMA) requiring extension of the endarterectomy and patch angioplasty on postoperative day 0, one due to stenosis at the distal edge of the endarterectomy 1 month postoperatively, successfully treated with SMA stenting, and one at 10-month follow-up due to SMA stenosis at the distal aspect of the endarterectomy, also successfully treated with SMA stenting. With these reinterventions, the 1-year primary patency in the paravisceral group was 40%, primary-assisted patency was 80%, and secondary patency was 100%. In the aortoiliac group, 1-year primary, primary-assisted, and secondary patency were 91%, 91%, and 100%, respectively. One patient developed iliac thrombosis 10 days postoperatively owing to an intimal flap distal to the endarterectomy site. She and one other patient, a young man with an undefined hypercoagulable disorder, ultimately required neoaortoiliac reconstructions at 18 and 32 months postoperatively, respectively (the latter in the setting of stopping anticoagulation). The remaining 13 patients experienced no complications. All patients had rapid resolution of clinical symptoms, and median postoperative ankle-brachial indexes of 1.06 on the right and 1.00 on the left, representing a median improvement from preoperative ankle-brachial indexes of +0.59 on the right and +0.56 on the left (P < .01 and P < .01).
CONCLUSIONS: In this series of 20 patients undergoing paravisceral and infrarenal aortoiliac endarterectomy, AE was associated with no perioperative mortality, relatively low and manageable morbidity, and excellent clinical outcomes in patients with both paravisceral and aortoiliac occlusive disease. SMA-related early reintervention was not uncommon in the paravisceral group, and attention should be given particularly to the distal endarterectomy site. AE remains a viable treatment for severe multivessel paravisceral or aortoiliac occlusive disease isolated to the aorta and common iliac arteries in select patients.
摘要：
目的：主动脉内膜切除术（AE），曾经是主髂动脉闭塞性疾病的首选治疗方法，现在很少进行血管内手术或开放式主动脉口经分流术。然而,在选择患有胸旁或主动脉闭塞性疾病的患者中，AE仍然是血运重建的可行替代方法，或者作为一个主要程序，或在先前的干预失败后。这里,我们评估了一系列接受经皮旁动脉或主动脉动脉内膜切除术的患者的结局，证明这些手术可以是一个很好的选择，在适当选择的患者中具有可接受的发病率和死亡率。
方法：对2017-2023年期间发生AE的20例患者进行了单机构回顾性研究。
结果：5例患者（25%）接受了耳膜旁动脉内膜切除术，15例（75％）接受了主动脉动脉内膜切除术。没有围手术期死亡。一名近宫患者在术后三个月死于肺炎并发症。胸膜旁组的三名患者需要再次干预；一个急性是由于SMA血栓形成，需要在术后第0天进行动脉内膜切除术和补片血管成形术，一个是由于术后1个月动脉内膜切除术远端边缘狭窄，SMA支架成功治疗，和一个在10个月的随访，由于SMA狭窄在动脉内膜切除术的远端，SMA支架也成功治疗。通过这些重新干预，胸旁组的一年原发性通畅率为40%，初级辅助通畅率为80%，继发性通畅率为100%。在主髂动脉组中，一年小学，初级辅助和次级通畅率为91%，91%,100%,分别。由于动脉内膜切除术部位远端的内膜瓣，一名患者在术后10天出现了髂动脉血栓形成。她和另一个病人,一名年轻男性患有不明确的高凝紊乱，最终需要在术后18个月和32个月进行新主动脉重建，分别（后者在停止抗凝的情况下）。其余13例患者未出现并发症。所有患者临床症状迅速缓解,术后中位ABI为右侧1.06，左侧1.00，代表术前ABI的中位数改善，右侧为0.59，左侧为0.56（p<0.01和p<0.01）。
结论：在这一系列的20例患者中，这些患者都接受了胸旁和肾下主动脉动脉内膜切除术，AE与无围手术期死亡相关，发病率相对较低且可控，和优秀的临床结果在患者的胸膜旁和主髂动脉闭塞性疾病。SMA相关的早期再干预在周边组并不少见，应特别注意远端动脉内膜切除术部位。AE仍然是某些患者中孤立于主动脉和CI的严重多血管角膜旁或主动脉闭塞性疾病的可行治疗方法。
方法：对2017-2023年期间发生AE的20例患者进行了单机构回顾性研究。
结果：5例患者（25%）接受了耳膜旁动脉内膜切除术，15例（75％）接受了主动脉动脉内膜切除术。没有围手术期死亡。一名近宫患者在术后三个月死于肺炎并发症。胸膜旁组的三名患者需要再次干预；一个急性是由于SMA血栓形成，需要在术后第0天进行动脉内膜切除术和补片血管成形术，一个是由于术后1个月动脉内膜切除术远端边缘狭窄，SMA支架成功治疗，和一个在10个月的随访，由于SMA狭窄在动脉内膜切除术的远端，SMA支架也成功治疗。通过这些重新干预，胸旁组的一年原发性通畅率为40%，初级辅助通畅率为80%，继发性通畅率为100%。在主髂动脉组中，一年小学，初级辅助和次级通畅率为91%，91%,100%,分别。由于动脉内膜切除术部位远端的内膜瓣，一名患者在术后10天出现了髂动脉血栓形成。她和另一个病人,一名年轻男性患有不明确的高凝紊乱，最终需要在术后18个月和32个月进行新主动脉重建，分别（后者在停止抗凝的情况下）。其余13例患者未出现并发症。所有患者临床症状迅速缓解,术后中位ABI为右侧1.06，左侧1.00，代表术前ABI的中位数改善，右侧为0.59，左侧为0.56（p<0.01和p<0.01）。
结论：在这一系列的20例患者中，这些患者都接受了胸旁和肾下主动脉动脉内膜切除术，AE与无围手术期死亡相关，发病率相对较低且可控，和优秀的临床结果在患者的胸膜旁和主髂动脉闭塞性疾病。SMA相关的早期再干预在周边组并不少见，应特别注意远端动脉内膜切除术部位。AE仍然是某些患者中孤立于主动脉和CI的严重多血管角膜旁或主动脉闭塞性疾病的可行治疗方法。
