大動脈腸骨閉塞性疾患に対する開腹手術の現代的結果

Despite the enduring importance of open surgical repair for complex aortoiliac occlusive disease (AIOD), advanced ischemia, or cases with failed endovascular therapy, there remains a notable gap in the current literature regarding contemporary outcomes of open surgery for AIOD. This study retrospectively analyzed six years of open revascularization procedures at our institution to evaluate perioperative outcomes, complications, and the influence of disease severity and procedure type.

A total of 60 patients (mean age 64.8 years; predominantly male) underwent open AIOD repair, with most classified as TASC D lesions. Most of them (72%) presented with advanced ischemia classified as Rutherford categories 4,5, or 6. The majority received aortobifemoral bypass (n=39), while others underwent axillobifemoral (n=8), axillofemoral (n=6), or iliofemoral (n=8) bypass procedures.

Acute kidney injury (AKI) occurred in 20% of patients, primarily following aortobifemoral bypass (28%). Postoperative AKI was associated with significantly lower pre-operative renal function. Dialysis and major cardiovascular events each affected 3.3% of the cohort. Fourteen percent required amputation, predominantly among those with higher Rutherford classifications (up to 67% in stage 6). The mean hospital length of stay was 21.5 days; ICU admission was necessary in 44% of cases (mean duration 1.8 days). Thirty-day mortality was 1.7%. Aortobifemoral bypasses were more frequently performed in younger, patients and were associated with increased complication rates. In contrast, axillobifemoral and axillofemoral bypasses, performed in older and high-risk populations, were linked to fewer complications. Iliofemoral bypasses were associated with the longest hospital stays but minimal complications. Statistical analysis demonstrated significant differences among the groups (p < 0.05).

At our center, open surgical management of AIOD yielded low perioperative mortality and acceptable morbidity rates. AKI was frequent, particularly in patients undergoing aortobifemoral bypass and those with less advanced ischemia. Amputation rates and hospital stays increased with greater disease severity. Both the revascularization technique and Rutherford classification significantly impacted perioperative outcomes.