Caracterización clínica y quirúrgica de pacientes con enfermedad arterial periférica aortoilíaca / Clinical and surgical characterization of patients with aortoiliac peripheral artery disease

Se realizó un estudio observacional y descriptivo, de serie de casos, de 14 pacientes con enfermedad arterial periférica aortoilíaca, operados por procedimientos vasculares directos en el Servicio de Angiología y Cirugía Vascular del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, de enero del 2010 a octubre del 2012, con vistas a caracterizarles según algunos parámetros clínicos y quirúrgicos y así evaluar la efectividad del tratamiento quirúrgico. Entre los principales resultados se obtuvo que el total de la serie eran hombres de más de 50 años de edad, en quienes se efectuó la ecografía Doppler como técnica imagenológica de elección; todos los afectados con oclusiones eran fumadores y de ellos, 50 % recibió revascularización quirúrgica, mientras que la totalidad de pacientes con aneurismas padecía hipertensión arterial y en 62,5 % de estos se practicó la cirugía de sustitución vascular. Se concluyó que la enfermedad arterial periférica aortoilíaca oclusiva tiene una aparición cada vez más temprana, los aneurismas de la aorta abdominal no son diagnosticados precozmente, las angiografías y tomografías son estudios necesarios para decidir el tratamiento quirúrgico, y que los parámetros quirúrgicos, como el tiempo de pinzamiento de la aorta, la diuresis durante el pinzamiento, la diuresis total y el tiempo quirúrgico; no tuvieron graves repercusiones en el período posoperatorio, ni en la supervivencia de los pacientes.

An observational and descriptive study of case series was conducted in 14 patients with aortoiliac peripheral artery disease, operated through direct vascular procedures at the Department of Angiology and Vascular Surgery of "Saturnino Lora Torres" Provincial Teaching Clinical Surgical Hospital in Santiago de Cuba, from January 2010 to October 2012, to characterize them according to some clinical and surgical parameters and evaluate the effectiveness of the surgical treatment. Among the main results it was obtained that the total number were men over 50 years of age in whom the Doppler ultrasound was selected as imaging technique; all patients with occlusions were smokers and 50% of them underwent bypass surgery, whereas all patients with aneurysms had hypertension and 62.5% of them underwent vascular replacement surgery. It was concluded that occlusive aortoiliac peripheral artery disease has an increasingly early onset, abdominal aortic aneurysms are not diagnosed early, and angiography and CT studies are needed to decide the surgical treatment, and surgical parameters such as time of aortic clamping, diuresis during clamping, urine output and surgical time had no serious implications in the postoperative period or survival of patients.

Surgical Treatment for Aortoiliac Occlusions

PURPOSE: To evaluate the efficacy of surgical treatment for multilevel aortoiliac occlusive diseases, we retrospectively analyzed 89 recent cases surgical treatment was used. METHODS: From March 1992 to July 2001, we performed 62 aortobifemoral bypasses and 27 other bypasses as primary procedures. We analyzed surgical indications, combined diseases, cardiac risk assessment, type of occlusion, treatment modalities and cumulative patency rate. RESULTS: In 59 aortobifemoral bypasses, 8 end-to-end and 51 end-to-side proximal anastomoses were performed. Adjuvant PTA, with or without stent before bypass operation, was performed in 13 cases. Types of occlusions were Rutherford type I in 18.0%, type II in 20.2% and type III in 61.8%, respectively. Associated diseases were hypertension, diabetes, cerebrovascular accidents, and myocardial infarction in order of frequency. Mean follow-up duration was 36.4 months. Cumulative patency rate by life table analysis was 77.5%. Leg or foot amputations were performed in 13 cases (14.6%) after bypass operations. Two cases of amputation were performed after 13 simultaneous infrainguinal bypasses, and in 4 cases after staged infrainguinal bypasses. Operative mortality occured in 4 cases (4.5%). CONCLUSION: Aortobifemoral bypass remains one of the most durable and effective arterial reconstructions, for extensive aortoiliac occlusive diseases in young patients with low operative risk. Simultaneous infrainguinal bypass is preferred in patients with poor distal run-off.

Clinical Analysis of Aortoiliac Occlusive Disease

PURPOSE: Aortoiliac occlusve diseases are common disease of chronic artherosclerosis in patients in lower extremities. We compared the operative results of anatomic reconstruction with those of an extraanatomic bypass to evaluate the true benefit of one over other procedure. METHOD: 115 patients who underwent surgery from January 1995 to May 2001 were retorspectively reviewed. The patients were classified in two group: a direct anatomic reconstruction group and an extraanatomic bypass group. Operative risk were analyzed by the scoring system recommended by the Subcommittee on Reporting Standards for Lower Extremity Ischemia of International Society for Cardiovascular Surgery(ISCVS). Risk factor, graft patency were analyzed between two group. RESULT: Graft patiency was better in anatomic reconstruction but it was not statistically significant. The important risk factors in deciding the extraanatomic bypass were age and degree of the organ injury, especially heart disease. CONCLUSION: Preoperative evaluation of the risk factors was important in decision making but statistically not significant. Patency of the deep femoral artery was sufficient for runoff and extensive profundaplasty prevented the femorodistal bypass.

Treatment of Aortoiliac Occlusions According to Multiple Competiting Therapeutic Options

The aortoiliac segment is one of the common site of chronic arterial occlusive disease which causes ischemic symptoms in the legs and feet. From March 1992 to December 1997, we performed 45 aortobifemoral bypasses, 14 femorofemoral bypasses, 3 iliofemoral bypasses, 1 ilioiliac bypass and 2 axillobifemoral bypasses. In 45 aortofemoral bypasses, 8 end-to-end proximal anastomosis and 37 side-to-end anastomosis were done. Adjuvant PTA with/without stent insertion before bypass operation were performed in 10 cases. Occlusive patterns of the disease were type I in 10.9%, type II in 23.5% and type III in 65.6% respectively. Associated diseases were hypertension, diabetes, cerebrovascular accidents, and myocardial infarction in order of frequency. In cardiac risk analysis according to the Eagle's criteria, high risk group was 4.7%, intermediate risk group was 53.1% and low risk group was 42.2% of total. Mean duration of follow-up was 12.1 months. Cumulative patency rate by life table analysis was 83.1%. Leg or foot amputations were done in 10 cases (15.6%) after operation and graft occlusion in 11 cases (17.2%). Two cases of amputation were done after 12 simultaneous infrainguinal bypasses, but 4 cases of after 10 staged infrainguinal bypasses. Operative mortality were 3 cases (4.7%). Conclusively, aortobifemoral bypass is still standard procedure in extensive aortoiliac occlusive disease in patients with low operative risk. And simultaneous infrainguinal bypass is preferred in patients with poor distal run-off. Alternatively, iliofemoral or extraanatomical bypasses are also considered case by case.