■肾下主动脉闭塞(IAO)是一种威胁生命的疾病,通常会导致下肢缺血。尽管开放手术是目前一线治疗的建议,最近的技术创新使血管内治疗(EVT)成为一种有希望的替代方法。本研究旨在比较旁路手术和EVT治疗IAO的临床效果。
■本研究是北京协和医院的一项单中心回顾性观察研究。在2011年至2021年之间,连续92例慢性和动脉粥样硬化性IAO患者接受了EVT(n=40)或旁路手术(n=52)治疗。基线临床因素(包括人口统计数据和合并症),围手术期数据(包括卢瑟福分类变化,技术成功率)和并发症发生率进行了评估。评估了EVT和旁路手术的中期通畅性和总体生存率。随访定义为从手术到最后一次门诊就诊的时间。连续变量和类别变量进行了统计比较,分别。对血管通畅性进行Kaplan-Meier生存分析。
■研究发现,人口统计学和术前卢瑟福分类在两组之间分布均匀(P>0.05)。至于技术上的成功,临床成功,合并症,死亡率,并发症发生率,和卢瑟福分类后的程序,差异无统计学意义(P>0.05)。EVT组术后平均住院时间为5.15天,明显短于搭桥组,11.83天(P<0.0001)。至于短期和长期结果,1-,3-,5年原发性通畅率为81.8%,73.1%,EVT组为73.1%,为97.8%,80.6%,搭桥术组为80.6%。旁路组的原发通畅性明显较好(P=0.034)。二次通畅率存在显着差异(Bypass100%vs.EVT81.6%;P=0.005)。此外,搭桥手术组的生存率高于EVT组(P=0.035)。
■尽管EVT的主要通畅率低于搭桥手术,其安全性和有效性仍与IAO的解剖搭桥手术相当,围手术期并发症较轻,住院时间较短.因此,EVT可能是IAO的可行选择。
UNASSIGNED: Infrarenal aortic occlusion (IAO) is a life-threatening condition that often causes lower limb ischemia. Although open surgery is the current recommendation for first-line treatment, recent technological innovations have made endovascular treatment (EVT) a promising alternative. This study aims to compare the clinical outcomes of bypass surgery and EVT in the treatment of IAO.
UNASSIGNED: This study is a single-center retrospective observative study at Peking Union Medical College Hospital. Consecutive 92 patients with chronic and atherosclerotic IAO were treated with either EVT (n=40) or bypass surgery (n=52) between 2011 and 2021. The baseline clinical factors (including demographic data and comorbidities), perioperative data (including Rutherford classification changes, technical success) and complication rates were evaluated. The mid-term patency and overall survival of EVT and bypass were assessed. Follow-up was defined as the time from surgery to the last outpatient visit. Continuous variables and category variables were statistically compared, respectively. Kaplan-Meier survival analyses were conducted for vascular patency.
UNASSIGNED: The study found that the demographics and pre-operative Rutherford classification were evenly distributed between the two groups (P>0.05). As for technical success, clinical success, comorbidities, mortality, complication rate, and Rutherford classification after procedures, no significant differences were observed (P>0.05). The average post-procedure hospital stay was 5.15 days in the EVT group and was significantly shorter than that of the bypass group, which was 11.83 days (P<0.0001). As for short-term and long-term results, the 1-, 3-, and 5-year primary patency rates were 81.8%, 73.1%, and 73.1% in the EVT group and 97.8%, 80.6%, and 80.6% in the bypass group. The bypass group had significantly better primary patency (P=0.034). There was a significant difference in the secondary patency rate (Bypass 100% vs. EVT 81.6%; P=0.005). Moreover, survival rates were higher in the bypass surgery group than in the EVT group (P=0.035).
UNASSIGNED: Although EVT\'s primary patency rate was lower than that with the bypass surgery, its safety and efficacy were still comparable to anatomic bypass surgery for IAO with less severe perioperative complications and shorter hospital stay. Therefore, EVT could be a feasible option for IAO.