Gefäßchirurgische Langzeitergebnisse – Vergleich orthotoper und extraanatomischer Rekonstruktionen bei unilateralen Beckenachsenverschlüssen über 10 Jahre

Zusammenfassung

Einleitung

Bei der pAVK sind zumeist mehrere Gefäßregionen betroffen, die Beckenachse in 35% der Fälle. Zur Rekanalisation sind interventionell-radiologische/endovaskuläre bzw. Hybrideingriffe etabliert, sodass Bypassverfahren zwar zunehmend in den Hintergrund treten, jedoch nicht an Bedeutung verlieren.

Ziel

Untersuchung unilateraler Beckenarterienverschlüsse (Einschlusskriterium), die entweder durch Implantation eines orthotopen oder extraanatomischen Bypasses (oBP/eaBP) saniert wurden.

Methode

Über einen definierten Zeitraum wurden im Vergleich der Rekonstruktionsverfahren Offenheitsrate, Komplikationen (Häufigkeit, Art, Schwere) zur Charakterisierung von Morbidität, Letalität und Ausmaß der klinischen Verbesserung nach BP-Implantation im Rahmen einer klinisch-systematischen, unizentrischen Beobachtungsstudie (Design) analysiert. Die Erstellung der Studienmethode erfolgte nicht explizit anhand der STROBE-Kriterien, entsprechen diesen aber im Wesentlichen.

Ergebnisse

Über 10 Jahre wurden 122 pAVK-Patienten (50% im Stadium IIb–Stadium III und IV paritätisch verteilt; Durchschnittsalter: 63 [Streubreite: 44–87] Jahre; mehrheitlich ASA III) eingeschlossen bei ebenso vielen Rekonstruktionen: 71 Patienten erhielten einen eaBP („Cross-over“), 51 Patienten einen iliacofemoralen (orthotopen – oBP) Bypass (kein signifikanter Unterschied hinsichtlich Häufigkeit noch Anzahl der Risikofaktoren pro Patient).

Schlussfolgerung

Der oBP ist dem eaBP bez. der Analyseparameter Offenheits-, Komplikationsrate sowie Letalität nicht überlegen. Des Weiteren muss die extraanatomische Revaskularisation nicht allein dem Polymorbiden vorbehalten bleiben.

Abstract

Introduction

In PAOD, several vascular regions are usually affected, the pelvic axis in 35% of cases. Interventional-radiological/endovascular or hybrid interventions have been established for recanalization, so that bypass procedures are increasingly taking a back seat, but are not losing their importance.

Objective

To study unilateral iliac artery occlusions (inclusion criterion) that were repaired either by implantation of an orthotopic or extraanatomic bypass (oBP/eaBP).

Methods

Over a defined period of time, the rate of open vessel, complications (frequency, type, severity) to characterize morbidity and mortality as well as the extent of clinical improvement after BP implantation were analyzed in a clinical-systematic, single-center observational study (for vascular surgical quality assurance and contribution to vascular medical-clinical health care research). The study method was not explicitly based on the STROBE criteria, but essentially corresponds to them.

Results

Over 10 years, 122 PAOD patients (50% in stage IIb–stage III and IV equally distributed; mean age: 63 [range, 44–87] years; majority ASA III) were included with the same number of reconstructions: 71 patients received an eaBP (“crossover”), 51 patients an iliacofemoral (orthotopic – oBP) bypass (neither significant difference regarding frequency nor number of risk factors per patient).

Conclusion

The oBP is not superior to eaBP with regard to the analysis parameters of openness, complication rate and mortality. Furthermore, extraanatomic revascularization does not have to be reserved for polymorbid patients only.

Schlüsselwörter

unilateraler Beckenachsenverschluss - orthotopic und extraanatomische Arterienrekonstruktion - frühpostoperatives und Langzeit-Outcome - offene gefäßchirurgische Intervention

Keywords

unilateral iliac artery occlusion - orthotopic and extra-anatomic arterial reconstruction - early postoperative and long-term outcome - open vascularsurgical intervention

Publication History

Received: 12 January 2024

Accepted after revision: 07 May 2024

Article published online:
17 June 2024

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