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  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Budapest
  • 2 Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Érsebészeti és Endovaszkuláris Tanszék, Budapest, Városmajor u. 68., 1122
  • 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Budapest

Összefoglaló. Bevezetés: A diffúz aortobiiliacalis érszakasz occlusiv betegségének kezelésére alkalmazott aortobifemoralis bypass szerepe csökken az endovascularis műtétek térnyerése miatt. Célkitűzés: A vizsgálat célja volt a modern invazív kezelés korszakában a perioperatív és a hosszú távú eredmények elemzése aortobiiliacalis bypass után, melyek összehasonlíthatók az endovascularis megoldások eredményeivel. Módszerek: A retrospektív, egycentrumú vizsgálat során a Semmelweis Egyetem Városmajori Szív- és Érgyógyászati Klinikájának Érsebészeti és Endovaszkuláris Tanszékén 2006. 01. 01. és 2017. 12. 31. között occlusiv aortoiliacalis atherosclerosis miatt primer aortobifemoralis bypass műtéten átesett 419 beteg (átlagéletkor: 62,2 év, SD: ± 8,22; 224 férfi, 53%) adatait elemeztük. Eredmények: A posztoperatív 30 napon belüli mortalitás 5,01%, a késői mortalitás 10,98% és 29,59% volt 12, illetve 60 hónap után. A betegek 12,57%-ánál történt korai reoperáció, késői reoperáció 32 (8%) betegnél vált szükségessé. A graft elsődleges nyitva maradása 88,65% és 81,15% volt 12, illetve 60 hónap után. 21 betegnél történt amputáció (6,29%); 57,14%-ban femoralis, 35,71%-ban cruralis szinten, 7,14%-ban a boka szintje alatt. Az amputációkra 35,71%-ban a bypasst követő 30 napon belül, további 35,71%-ban 2 éven belül került sor. Az esetek 35,63%-ában lépett fel egyéb szövődmény; a leggyakoribbak: műtétet igénylő posztoperatív hernia (6,89%), cardiovascularis szövődmény (4,19%), lágyéki nyirokcsorgás vagy sebgyógyulási zavar (4,79%). Következtetés: Eredményeink alapján e betegcsoportban az aortobifemoralis bypass elfogadható, de nem jelentéktelen perioperatív halálozással és magas morbiditással jár. A graft hosszú távú nyitva maradása jó, de az újabb érműtét mind rövid, mind hosszú távon relatíve gyakori. A kevésbé invazív technikák eredményeinek összehasonlítása indokolt a hosszú szakaszú (TASC C, D) elváltozások esetén. Orv Hetil. 2021; 162(3): 99–105.

Summary. Introduction: The role of aorto-bifemoral bypass in the treatment of diffuse aorto-biiliac occlusive disease decreases in the era of endovascular surgery. Objective: The aim of the study was to analyse the early and long-term postoperative results of aorto-bifemoral bypass in a recent time period. These results may be used as a baseline to compare the results of endovascular procedures. Methods: In a retrospective, single-center study, the data of 419 patients (mean age: 62.2 years, SD: ± 8.22; 224 men, 53%) who underwent primary aorto-bifemoral bypass due to occlusive aorto-iliac atherosclerosis from 01. 01. 2006 to 31. 12. 2017 at the Department of Vascular and Endovascular Surgery of Semmelweis University Heart and Vascular Center were analysed. Results: Postoperative mortality within 30 days was 5.01%, late mortality was 10.98% and 29.59% after 12 and 60 months, respectively. 12.57% of the patients needed early reoperation and late reoperation was required in 32 cases (8%). The primary graft patency was 88.65% and 81.15% after 12 and 60 months, respectively. 21 patients underwent amputation (6.29%); 57.14% at the femoral level, 35.71% at the crural level and 7.14% below the ankle level. Amputations were performed in 35.71% of the cases within 30 days after the bypass and an additional 35.71% within 2 years. Other complications occurred in 35.63% of the cases; the most common causes were postoperative hernia requiring surgery (6.89%), cardiovascular complication (4.19%) and inguinal wound healing disorders (4.79%). Conclusion: Based on our results, aorto-bifemoral bypass surgery is associated with acceptable but not insignificant perioperative mortality and high morbidity in this group of patients. The graft patency is favourable in the long term, however, additional vascular reintervention is common in short and long term as well. Short- and long-term results of percutaneous endovascular techniques in diffuse aorto-biiliac disease (TASC C and D lesions) are suggested to be compared to these recent results of open surgery. Orv Hetil. 2021; 162(3): 99–105.

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  • 1

    Sidawy AN, Perler BA. (ed.) Rutherford’s Vascular Surgery and Endovascular Therapy. Elsevier, Philadelphia, PA, 2018.

  • 2

    Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007; 45(Suppl): S5–S67.

  • 3

    de Vries SO, Hunink MG. Results of aortic bifurcation grafts for aortoiliac occlusive disease: a meta-analysis. J Vasc Surg. 1997; 26: 558–569.

  • 4

    Danczyk RC, Mitchell EL, Petersen BD, et al. Outcomes of open operation for aortoiliac occlusive disease after failed endovascular therapy. Arch Surg. 2012; 147: 841–845.

  • 5

    Lee GC, Yang SS, Park KM, et al. Ten year outcomes after bypass surgery in aortoiliac occlusive disease. J Korean Surg Soc. 2012; 82: 365–369.

  • 6

    Ozcan AV, Emrecan B, Gökşin I. Aortobifemoral bypass via paramedian incision and retroperitoneal approach for aortoiliac occlusive disease. Acta Chir Belg. 2013; 113: 182–186.

  • 7

    Reed AB, Conte MS, Donaldson MC, et al. The impact of patient age and aortic size on the results of aortobifemoral bypass grafting. J Vasc Surg. 2003; 37: 1219–1225.

  • 8

    Sharma G, Scully RE, Shah SK, et al. Thirty-year trends in aortofemoral bypass for aortoiliac occlusive disease. J Vasc Surg. 2018; 68: 1796–1804.e2.

  • 9

    Davies AH, Ramarakha P, Collin J, et al. Recent changes in the treatment of aortoiliac occlusive disease by the Oxford Regional Vascular Service. Br J Surg. 1990; 77: 1129–1131.

  • 10

    Ali AT, Modrall GJ, Lopez J, et al. Emerging role of endovascular grafts in complex aortoiliac occlusive disease. J Vasc Surg. 2003; 38: 486–491.

  • 11

    Mouanoutoua M, Maddikunta R, Allaqaband S, et al. Endovascular intervention of aortoiliac occlusive disease in high-risk patients using the kissing stents technique: long-term results. Catheter Cardiovasc Interv. 2003; 60: 320–326.

  • 12

    Rzucidlo EM, Powell RJ, Zwolak RM, et al. Early results of stent-grafting to treat diffuse aortoiliac occlusive disease. J Vasc Surg. 2003; 37: 1175–1180.

  • 13

    Jongkind V, Akkersdijk GJ, Yeung KK, et al. A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. J Vasc Surg. 2010; 52: 1376–1383.

  • 14

    Tiek J, Remy P, Sabbe T, et al. Laparoscopic versus open approach for aortobifemoral bypass for severe aorto-iliac occlusive disease. A multicentre randomised controlled trial. Eur J Vasc Endovasc Surg. 2012; 43: 711–715.

  • 15

    Indes JE, Pfaff MJ, Farrokhyar F, et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and metaanalysis. J Endovasc Ther. 2013; 20: 443–455.

  • 16

    Dorigo W, Piffaretti G, Benedetto F, et al. A comparison between aortobifemoral bypass and aortoiliac kissing stents in patients with complex aortoiliac obstructive disease. J Vasc Surg. 2017; 65: 99–107.

  • 17

    Groot Jebbink E, Holewijn S, Slump CH, et al. Systematic review of results of kissing stents in the treatment of aortoiliac occlusive disease. Ann Vasc Surg. 2017; 42: 328–336.

  • 18

    Groot Jebbink E, Holewijn S, Versluis M, et al. Meta-analysis of individual patient data after kissing stent treatment for aortoiliac occlusive disease. J Endovasc Ther. 2019; 26: 31–40.

  • 19

    Quan C, Kim DH, Jung HJ, et al. Comparison of results between kissing stent and aortic bifurcated bypass in aortoiliac occlusive disease. Asian J Surg. 2020; 43: 186–192.

  • 20

    Antonello M, Squizzato F, Bassini S, et al. Open repair versus endovascular treatment of complex aortoiliac lesions in low risk patients. J Vasc Surg. 2019; 70: 1155–1165.e1.

  • 21

    Karpenko AA, Starodubtsev VB, Ignatenko PV, et al. Results of endovascular interventions in patients with occlusive stenotic lesions of arteries of the aortoiliac segment. Angiol Sosud Khir. 2016; 22: 77–82. [Russian]

  • 22

    Thomas AT, Leitman IM. Predictors of serious morbidity and mortality after endovascular repair of aortoiliac lesions. Surgery 2018; 164: 365–369.

  • 23

    Pepe RJ, Patel P, Huntress LA, et al. Endovascular reconstruction for chronic infrarenal aortoiliac occlusive disease. Ann Vasc Surg. 2017; 45: 263.e211–263.e217.

  • 24

    Van Haren RM, Goldstein LJ, Velazquez OC, et al. Endovascular treatment of TransAtlantic Inter-Society Consensus D aortoiliac occlusive disease using unibody bifurcated endografts. J Vasc Surg. 2017; 65: 398–405.

  • 25

    Bracale UM, Giribono AM, Spinelli D, et al. Long-term results of endovascular treatment of TASC C and D aortoiliac occlusive disease with expanded polytetrafluoroethylene stent graft. Ann Vasc Surg. 2019; 56: 254–260.

  • 26

    Gabel JA, Kiang SC, Abou-Zamzam AM Jr, et al. Trans-Atlantic Inter-Society Consensus class D aortoiliac lesions: a comparison of endovascular and open surgical outcomes. Am J Roentgenol. 2019; 213: 696–701.

  • 27

    Mayor J, Branco BC, Chung J, et al. Outcome comparison between open and endovascular management of TASC II D aortoiliac occlusive disease. Ann Vasc Surg. 2019; 61: 65–71.e3.

  • 28

    DeCarlo C, Boitano LT, Schwartz SI, et al. Operative complexity and prior endovascular intervention negatively impact morbidity after aortobifemoral bypass in the modern era. Ann Vasc Surg. 2020; 62: 21–29.

  • 29

    Vértes M, Juhász IZ, Nguyen TD, et al. Stent protrusion >20 mm into the aorta: a new predictor for restenosis after kissing stent reconstruction of the aortoiliac bifurcation. J Endovasc Ther. 2018; 25: 632–639.