Natural history of common iliac arteries after aorto-aortic graft insertion during elective open abdominal aortic aneurysm repair: A prospective study
Natural history of common iliac arteries after aorto-aortic graft insertion during elective open abdominal aortic aneurysm repair: A prospective study
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DOI：
10.1016/j.surg.2008.07.011
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发表时间：
2008-11-01
期刊：
影响因子：
3.8
通讯作者：
Toniato, Antonio
中科院分区：
文献类型：
--
作者：
Ballotta, Enzo;Da Giau, Giuseppe;Toniato, Antonio
背景资料。本研究旨在了解选择性肾下腹主动脉瘤(AAA)人工血管修补术后髂总动脉(CIA)的自然病史。所有在1995-2005年间进行AAA修补术的患者均接受了手术前和术后的CT扫描，以监测CIA直径的变化；他们最近一次CT扫描是在2007年进行的。根据术前CIA直径分为A组(两个CIA均正常，直径最大12 mm)、B组(至少1个扩张型CIA，直径13~18 mm)和C组(至少1个动脉瘤样CIA，直径19~25 mm)。平均随访7.1年(2.1~12.3年)。符合研究条件的201例患者中，A组92例(45.8%)，B组63例(31.3%)，C组46例(22.9%)。共有14个CIAs(5.4%)从“正常”进展为“扩张型”，9个CIAs(10.2%)从“扩张型”进展为“动脉瘤”。3个动脉瘤样的CIAS略超过25 mm的门槛，但没有一个得到修复。无一例患者表现为闭塞性髂动脉疾病的进展或发展，或因CIA过度增大而需要再次手术。这一分析表明，在AAA修复过程中，大多数CIAs在插管后不会扩张，而且当它们扩张时，扩张程度很小。即使对于扩张性或中度动脉瘤性CIA，在AAA修复过程中插入管子也是合理的，而且该过程是安全和持久的。围绕它的选择性使用而不是系统性的分叉移植物放置的怀疑似乎是没有根据的。(《外科手术2008》；144：822-6。)
Background. This study aimed to determine the natural history of common iliac arteries (CIAs) after elective open infrarenal abdominal aortic aneurysm (AAA) repair with an aorto-aortic prosthetic graft.Methods. All patients who had a straight lube graft inserted during elective AAA repair to institution between 1995 and 2005 were prospectively followed up with preoperative and postoperative computed tomography (CT) scans to monitor changes in CIA diameter; their latest CT scan was performed in 2007. Based on preoperative CIA diameter, patients were divided into groups A (both CIAs normal, up to to 12 mm in diameter), B (at least 1 ectatic CIA, 13-18mm), and C (at least 1 aneurysmal CIA, 19-25 mm). The mean follow-up was 7.1 years (range, 2.1-12.3 years).Results. Among 201 patients eligible for the study, 92 patients (45.8%) were in group A, 63 patients (31.3%) were in group B, and 46 patients (22.9%) wee in group C. Overall, the diameter increased in 119 CIAs (29.6%) by a mean of 1.1, 1.8, and 2.4 mm in groups A, B, and C, respectively. In all, 14 CIAs (5.4%) progressed from "normal" to ectatic," and 9 CIAs (10.2%) progressed form "ectatic" to "aneurysmal." Three aneurysmal CIAS slightly exceeded the 25-mm threshold, but none of these were repaired. No patients showed a progression or development of occlusive iliac artery disease or required repeat operation because of excessive CIA enlargement.Conclusions. This analysis showed that most CIAs do not expand after tube graft insertion during AAA repair, and when they do, the degree of dilation is minimal. Tube graft insertion during AAA repair is justified even for ectatic or moderately aneurysmal CIAs, and the procedure is safe and durable. The skepticism surrounding its selective use instead of a systematic bifurcated graft placement seems to be unwarranted. (Surgery 2008;144:822-6.)