目的:考虑患者的解剖结构和血管状况,主动脉-股动脉旁路术是腹主动脉瘤开放修复的治疗方法。本研究旨在评估残余髂动脉的变化及其与股吻合术逆行血流保存状态的相关性。
方法:对2007年至2022年在釜山国立大学医院接受腹主动脉瘤手术的221例患者,这项回顾性队列研究包括29例接受主动脉-股动脉旁路术的患者。在这些病人中,21例接受了主动脉-股动脉旁路术,8例接受了主动脉-股动脉旁路术。研究了术前到术后髂动脉大小的变化,以及这种大小差异是否取决于术后逆行血流的状态。此外,确定了影响总死亡率和缺血性并发症的因素.
结果:从手术到最后一次随访的中位持续时间为2069.5天(约5.7年)。患者平均年龄为78.1岁,男性比例为75.9%。在股吻合术后逆行血流消失的情况下,术后髂动脉大小较术前明显缩小(18.4±18.9mmvs.13.2±7.9mm,分别为;p=0.04)。保持逆行血流的组的残余髂总动脉尺寸明显大于血流消失的组。(20.0±28.0mmvs.14.6±8.5mm,分别为;p=0.02)。逆行血流的消失是手术后髂动脉尺寸缩小的一个重要因素(比值比,2.5;95%置信区间,1.9-5.3;p=0.02)。由于the动脉的大小增加,三名保持逆行血流的患者(18.8%)需要干预。通过Cox比例风险回归分析,显着影响总体死亡的因素是慢性阻塞性肺疾病(风险比,36.8;95%置信区间,1.6-870.0;p=0.03),外周动脉闭塞性疾病(风险比,12.7;95%置信区间,1.4-115.8;p=0.02),和逆行流的消失(危险比,8.7;95%置信区间,1.2-63.9;p=0.03)。
结论:在腹主动脉瘤的开放修复方法中,如果在进行主动脉-股骨搭桥术时未能通过股骨吻合术维持逆行血流,剩余髂动脉的大小减小。然而,逆行流的丧失增加了长期死亡率。当进行主动脉-股动脉旁路手术时,定期影像学随访是必要的,在适当的时间间隔,以检查残余髂动脉和逆行血流。
BACKGROUND: Considering a patient\'s anatomy and vascular conditions, aorto-femoral bypass is a treatment approach for the open repair of abdominal aortic aneurysms. This study aimed at evaluating changes in the remnant iliac artery and their correlation with the preservation state of retrograde flow from femoral anastomosis.
METHODS: Of 221 patients who underwent abdominal aortic aneurysm surgery between 2007 and 2022 in Pusan National University Hospital, 29 patients who underwent aorto-femoral bypass were included in this retrospective cohort study. Of these patients, 21 underwent aortobifemoral bypass and 8 underwent aortoiliac-and-femoral bypass. The change in size of the iliac artery from preoperative to postoperative and whether this difference in size depended on the status of postoperative retrograde flow were investigated. Additionally, factors affecting overall mortality and ischemic complications were identified.
RESULTS: The median duration from operation to the last follow-up was 2069.5 days (about 5.7 years). The average age of the patients was 78.1 years, and the proportion of males was 75.9%. In cases of disappearance of postoperative retrograde flow from the femoral anastomosis, the postoperative iliac artery size was significantly reduced compared to its preoperative size (18.4 ± 18.9 mm vs. 13.2 ± 7.9 mm, respectively; P = 0.04). The group with maintained retrograde flow had significantly larger residual common iliac artery size than the group with disappearance of flow. (20.0 ± 28.0 mm vs. 14.6 ± 8.5 mm, respectively; P = 0.02). Disappearance of retrograde flow was a significant factor in the iliac artery size reduction after surgery (odds ratio, 2.5; 95% confidence interval, 1.9-5.3; P = 0.02). Three patients with maintained retrograde flow (18.8%) required intervention owing to an increase in the size of the iliac artery. The factors that significantly influenced overall death as analyzed by Cox proportional hazard regression were chronic obstructive pulmonary disease (hazard ratio, 36.8; 95% confidence interval, 1.6-870.0; P = 0.03), peripheral arterial occlusive disease (hazard ratio, 12.7; 95% confidence interval, 1.4-115.8; P = 0.02), and disappearance of retrograde flow (hazard ratio, 8.7; 95% confidence interval, 1.2-63.9; P = 0.03).
CONCLUSIONS: Among the open repair methods for abdominal aortic aneurysms, if retrograde flow was not maintained through femoral anastomosis when aorto-femoral bypass was performed, the size of the remaining iliac artery decreased. However, loss of retrograde flow increased long-term mortality. When aorto-femoral bypass is performed, regular imaging follow-up is necessary at appropriate intervals to check the remnant iliac artery and retrograde flow.