Реваскуляризация при поражении артерий аортоподвздошного сегмента. Обзор литературы и клинические примеры

В настоящей статье рассмотрены основные вопросы, касающиеся выбора тактики лечения больных с окклюзионно-стенотическими поражениями аорто-подвздошного сегмента. Продемонстрированы ключевые положения действующих российских, европейских и американских рекомендаций по реваскуляризации периферического русла. Уделено внимание последним исследованиям, сравнивающим результаты открытой хирургии и эндоваскулярных методов коррекции. Приведены клинические случаи, демонстрирующие оптимальные результаты применения интервенционных технологий в условиях протяженного гемодинамически значимого поражения и окклюзии подвздошных артерий. Сделано заключение о высокой эффективности и безопасности эндоваскулярной коррекции в лечении больных с атеросклеротическим поражением аорто-подвздошного сегмента. 

1. Kasemi H, Marino M, Dionisi CP, Di Angelo CL, Fadda GF. Seven-Year Approach Evolution of the Aortoiliac Occlusive Disease Endovascular Treatment. Ann Vasc Surg. 2016;30:277–285. PMID: 26370748 https://doi.org/10.1016/j.avsg.2015.07.016

2. Rutherford RB. Aortobifemoral bypass, the gold standard: technical considerations. Semin Vasc Surg. 1994;7(1):11–16. PMID: 8180750

3. Бурков Н.Н., Казанцев А.Н., Тарасов Р.С. Госпитальные исходы реконструктивных вмешательств на аорто-бедренном сегменте у пациентов с мультифокальным атеросклерозом. Ангиология и сосудистая хирургия. 2018;24(2):139–145.

4. Burke CR, Henke PK, Hernandez R, Rectenwald JE, Krishnamurthy V, Englesbe MJ, et al. A contemporary comparison of aortofemoral bypass and aortoiliac stenting in the treatment of aortoiliac occlusive disease. Ann Vasc Surg. 2010;24(1):4–13. PMID: 20122461 https://doi.org/10.1016/j.avsg.2009.09.005

5. Ahn S, Park KM, Kim YK, Kim JI, Moon IS, Hong KC, et al. Outcomes of endovascular treatment for TASC C and D aorto-iliac lesions. Asian J Surg. 2017;40(3):215–220. PMID: 26787498 https://doi.org/10.1016/j.asjsur.2015.11.006

6. Yuan L, Bao J, Zhao Z, Feng X, Lu Q, Jing Z. Endovascular therapy for long-segment atherosclerotic aortoiliac occlusion. J Vasc Surg. 2014;59(3):663–668. PMID: 24239521 https://doi.org/10.1016/j.jvs.2013.09.005

7. Швальб П.Г., Калинин Р.Е., Баранов С.В., Сучков И.А., Пшенников А.С. Сравнительная оценка результатов реконструктивных операций в аорто-подвздошном сегменте у больных с облитерирующим атеросклерозом артерий нижних конечностей. Ангиология и сосудистая хирургия. 2008;14(3):34–35.

8. Бурков Н.Н., Казанцев А.Н., Ануфриев А.И., Данилович А.И., Смирнов К.В., Лидер Р.Ю., и др. Результаты бедренно-подколенной реконструкции биологическим протезом «Кемангиопротез». Кардиология и сердечно-сосудистая хирургия. 2020;13(1):29–35. https://doi.org/10.17116/kardio202013011129

9. Tshomba Y, Melissano G, Apruzzi L, Baccellieri D, Negri G, Chiesa R. Open repair for aortic occlusive disease: indication, techniques, results, tips and tricks. J Cardiovasc Surg (Torino). 2014;55(2 Suppl 1):57–68. PMID: 24796898

10. Бурков Н.Н., Казанцев А.Н., Тарасов Р.С., Ануфриев А.И., Барбараш Л.С. Предикторы неблагоприятных исходов реконструктивных вмешательств на аортобедренном сегменте в отдаленном периоде наблюдения. Грудная и сердечно-сосудистая хирургия. 2018;60(1):55– 60.

11. Ghoneim B, Elsherif M, Elsharkawi M, Acharya Y, Hynes N, Tawfick W, et al. Outcomes of Unibody Bifurcated Endograft and Aortobifemoral Bypass for Aortoiliac Occlusive Disease. Vasc Specialist Int. 2020;36(4):216–223. PMID: 33361542 https://doi.org/10.5758/vsi.200051

12. Магомедов Ш.Г., Джуракулов Ш.Р. Сравнительный анализ результатов эндоваскулярных и открытых вмешательств при поражении артерий аорто-подвздошного сегмента. Хирургическая практика. 2018;34(2):28–32. https://doi.org/10.17238/issn2223-2427.2018.2.28-32

13. Бурков Н.Н., Казанцев А.Н., Тарасов Р.С., Ануфриев А.И., Барбараш Л.С. Результаты реконструктивных вмешательств на аортобедренном сегменте у пациентов с мультифокальным атеросклерозом. Хирургия. Журнал им. Н.И. Пирогова. 2018;(5):13–18. https://doi.org/10.17116/hirurgia2018513-18

14. Squizzato F, D’Oria M, Bozza R, Porcellato L, Grego F, Lepidi S. Propensity- Matched Comparison of Endovascular versus Open Reconstruction for TASC-II C/D AortoIliac Occlusive Disease. A TenYear Single-Center Experience with Self- Expanding Covered Stents. Ann Vasc Surg. 2021;71:84–95. PMID: 32927036 https://doi.org/10.1016/j.avsg.2020.08.139

15. Reijnen MM. Update on covered endovascular reconstruction of the aortic bifurcation. Vascular. 2020;28(3):225–232. PMID: 31896301 https://doi.org/10.1177/1708538119896197

16. Sixt S, Krankenberg H, Möhrle C, Kaspar M, Tübler T, Rastan A, et al. Endovascular treatment for extensive aortoiliac artery reconstruction: a single-center experience based on 1712 interventions. J Endovasc Ther. 2013;20(1):64–73. PMID: 23391085 https://doi.org/10.1583/12-4014.1

17. Затевахин И.И., Шиповский В.Н., Магомедов Ш.Г., Джуракулов Ш.Р. Результаты эндоваскулярного лечения атеросклеротических поражений подвздошных артерий. Диагностическая и интервенционная радиология. 2010;4(2):29–37.

18. Müller AM, Langwieser N, Bradaric C, Haller B, Fusaro M, Ott I, et al. Endovascular Treatment for Steno-Occlusive Iliac Artery Disease: Safety and Long-Term Outcome. Angiology. 2018;69(4):308–315. PMID: 28747061 https://doi.org/10.1177/0003319717720052

19. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33 Suppl 1:S1–75. PMID: 17140820 https://doi.org/10.1016/j.ejvs.2006.09.024

20. РекомендацииЕОК/ЕОСХ по диагностике и лечению заболеваний периферических артерий 2017. Российский кардиологический журнал. 2018;23(8):201–203. https://doi.org/10.15829/1560-4071-2018-8-164-221

21. Indes JE, Pfaff MJ, Farrokhyar F, Brown H, Hashim P, Cheung K, et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther. 2013;20(4):443–455. PMID: 23914850 https://doi.org/10.1583/13-4242.1

22. Grimme FA, Goverde PC, Verbruggen PJ, Zeebregts CJ, Reijnen MM. Editor’s choice–first results of the covered endovascular reconstruction of the aortic bifurcation (CERAB) technique for aortoiliac occlusive disease. Eur J Vasc Endovasc Surg. 2015;50(5):638–647. PMID: 26343310 https://doi.org/10.1016/j.ejvs.2015.06.112

23. Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, et al. Durable clinical effectiveness with paclitaxel-eluting stents in the femoropopliteal artery: 5-year results of the Zilver PTX randomized trial. Circulation. 2016;133(15):1472–1483. PMID: 26969758 https://doi.org/10.1161/CIRCULATIONAHA.115.016900

24. Anderson JL, Antman EM, Harold JG, Jessup M, O’Gara PT, Pinto FJ, et al. Clinical practice guidelines on perioperative cardiovascular evaluation: collaborative efforts among the ACC, AHA, and ESC. Circulation. 2014;130(24):2213–2214. PMID: 25085963 https://doi.org/10.1161/CIR.0000000000000103

25. Murphy TP, Cutlip DE, Regensteiner JG, Mohler ER, Cohen DJ, Reynolds MR, et al. Supervised exercise versus primary stenting for claudication resulting from aortoiliac peripheral artery disease: six-month outcomes from the Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) study. Circulation. 2012;125(1):130–139. PMID: 22090168 https://doi.org/10.1161/CIRCULATIONAHA.111.075770

26. Национальные рекомендации по диагностике и лечению заболеваний артерий нижних конечностей 2019. Москва, 2019. URL: http://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf [Дата обращения 22 ноября 2021 г.]

27. Dellehunt RE, Manna B. Aortofemoral Bypass. 2021 Feb 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. PMID: 31194468. Bookshelf ID: NBK542328

28. Katsuki T, Yamaji K, Hiramori S, Tomoi Y, Soga Y, Ando K. Ten-year clinical outcomes for patients undergoing lower extremity endovascular interventions. J Vasc Surg. 2020;72(5):1626–1635.e3. PMID: 32278575 https://doi.org/10.1016/j.jvs.2020.02.026

29. Premaratne S, Newman J, Hobbs S, Garnham A, Wall M. Meta-analysis of direct surgical versus endovascular revascularization for aortoiliac occlusive disease. J Vasc Surg. 2020;72(2):726–737. PMID: 32171442 https://doi.org/10.1016/j.jvs.2019.12.035

30. DeCarlo C, Boitano LT, Schwartz SI, Lancaster RT, Conrad MF, Eagleton MJ, et al. Laparotomy- and groin-associated complications are common after aortofemoral bypass and contribute to reintervention. J Vasc Surg. 2020;72(6):1976–1986. PMID: 32284209 https://doi.org/10.1016/j.jvs.2019.09.067

31. Mayor J, Branco BC, Chung J, Montero-Baker MF, Kougias P, Mills JL Sr, et al. Outcome Comparison between Open and Endovascular Management of TASC II D Aortoiliac Occlusive Disease. Ann Vasc Surg. 2019;61:65– 71.e3. PMID: 31394230 https://doi.org/10.1016/j.avsg.2019.06.005

32. Yamauchi Y, Takahara M, Iida O, Shintani Y, Sugano T, Yamamoto Y, et al.; OMOTENASHI investigators. Independent predictors of loss of primary patency at 1 year after aortoiliac stent implantation. Heart Vessels. 2020;35(5):614–619. PMID: 31642981 https://doi.org/10.1007/s00380-019-01524-9

33. Nanto K, Iida O, Fujihara M, Yokoi Y, Tomoi Y, Soga Y, et al. Five- Year Patency and its Predictors after Endovascular Therapy for Aortoiliac Occlusive Disease. J Atheroscler Thromb. 2019;26(11):989–996. PMID: 30996200 https://doi.org/10.5551/jat.45617

34. Piffaretti G, Fargion AT, Dorigo W, Pulli R, Gattuso A, Bush RL, et al.; ILIACS Registry Group. Outcomes from the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease. J Endovasc Ther. 2019;26(5):623–632. PMID: 31331235 https://doi.org/10.1177/1526602819863081

35. Quan C, Kim DH, Jung HJ, Lee SS. Comparison of results between kissing stent and aortic bifurcated bypass in aortoiliac occlusive disease. Asian J Surg. 2020;43(1):186–192. PMID: 30852072 https://doi.org/10.1016/j.asjsur.2019.02.002

36. Zhang B, Niu G, Yan Z, Zou Y, Tong X, Yang M. Midterm outcomes of endovascular treatment with bare metal stents for Leriche syndrome patients. Interact Cardiovasc Thorac Surg. 2021;32(1):83–88. PMID: 33221834 https://doi.org/10.1093/icvts/ivaa223

37. Tshomba Y, Melissano G, Apruzzi L, Baccellieri D, Negri G, Chiesa R. Open repair for aortic occlusive disease: indication, techniques, results, tips and tricks. J Cardiovasc Surg (Torino). 2014;55(2 Suppl 1):57–68. PMID: 24796898

38. Bracale UM, Giribono AM, Spinelli D, Del Guercio L, Pipitò N, Ferrara 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. PMID: 30339903 https://doi.org/10.1016/j.avsg.2018.07.060

39. Liang HL, Li MF, Hsiao CC, Wu CJ, Wu TH. Endovascular management of aorto- iliac occlusive disease (Leriche syndrome). J Formos Med Assoc. 2021;120(7):1485–1492. PMID: 33189506 https://doi.org/10.1016/j.jfma.2020.10.033

40. Pomozi E, Lengyel B, Osztrogonácz P, Nguyen DT, Szeberin Z. Longterm analysis of the results of aorto-bifemoral bypass surgery for diffuse aorto-biiliac occlusive disease. Orv Hetil. 2021;162(3):99–105. Hungarian. PMID: 33459610 https://doi.org/10.1556/650.2021.31970

41. Gabel JA, Kiang SC, Abou-Zamzam AM Jr, Oyoyo UE, Teruya TH, Tomihama RT. Trans-Atlantic Inter-Society Consensus Class D Aortoiliac Lesions: A Comparison of Endovascular and Open Surgical Outcomes. AJR Am J Roentgenol. 2019;213(3):696–701. PMID: 31120778 https://doi.org/10.2214/AJR.18.20918

42. Zanabili Al-Sibbai AA, Camblor Santervás LA, Álvarez Marcos F, Rivas Domínguez M, Del Castro Madrazo JA, Llaneza Coto JM, et al. Midterm Results of Endovascular Treatment for Complete Iliac Axis Occlusions Using Covered Stents. Ann Vasc Surg. 2020;63:241–249. PMID: 31626933 https://doi.org/10.1016/j.avsg.2019.07.024

43. Cheng M, Lavi P, Tran-McCaslin M, Chun L, Lew W, Patel K. Aortoiliac Endarterectomy: A Useful Tool in Modern Vascular Practice. Ann Vasc Surg. 2020;68:572.e5–572.e7. PMID: 32445884 https://doi.org/10.1016/j.avsg.2020.04.077

44. Shen CY, Liu YF, Li QL, Zhang YB, Jiao Y, Krokidis ME, et al. Open and Endovascular Treatment of Trans-Atlantic Inter-Society Consensus II D Aortoiliac Occlusive Lesions: What Determines the Rate of Restenosis? Chin Med J (Engl). 2015;128(22):3035–3042. PMID: 26608983 https://doi.org/10.4103/0366-6999.169053

45. Jia X, Guo W, Liu XP, Xiong J, Ma XH, Zhang HP, et al. The mid-term and long-term results of endovascular treatment of C/D aorto-iliac artery occlusive disease. Zhonghua Yi Xue Za Zhi. 2020;100(29):2273-2277. Chinese. PMID: 32746597 https://doi.org/10.3760/cma.j.cn112137-20200211-00251

46. Van Haren RM, Goldstein LJ, Velazquez OC, Karmacharya J, Bornak A. Endovascular treatment of TransAtlantic Inter-Society Consensus D aortoiliac occlusive disease using unibody bifurcated endografts. J Vasc Surg. 2017;65(2):398–405. PMID: 27765483 https://doi.org/10.1016/j.jvs.2016.08.084

47. Pereira-Macedo J, Machado N, Pereira-Neves A, Ferreira V, OliveiraPinto J, Dias-Neto M, et al. Myocardial injury after aortoiliac revascularization for extensive disease: A survival analysis. Turk Gogus Kalp Damar Cerrahisi Derg. 2020;28(3):426–434. PMID: 32953204 https://doi.org/10.5606/tgkdc.dergisi.2020.20100 eCollection 2020 Jul.

48. Rigatelli G, Zuin M, Dell’Avvocata F, Nanjundappa A, Daggubati R, Nguyen T. Non-invasive Evaluation of Fluid Dynamic of Aortoiliac Atherosclerotic Disease: Impact of Bifurcation Angle and Different Stent Configurations. J Transl Int Med. 2018;6(3):138–145. PMID: 30425950 https://doi.org/10.2478/jtim-2018-0020 eCollection 2018 Sep.

49. Папоян С.А., Щеголев А.А., Громов Д.Г., Квицаридзе Б.А., Сазонов М.Ю., Гавриленко А.В. Результаты эндоваскулярного лечения больных с поражениями аорто-подвздошного сегмента типов С и D по классификации TASC II. Ангиология и сосудистая хирургия. 2016;22(3):75-59.

50. Reijnen MM. Update on covered endovascular reconstruction of the aortic bifurcation. Vascular. 2020;28(3):225–232. PMID: 31896301 https://doi.org/10.1177/1708538119896197

51. Ghoneim B, Elsherif M, Elsharkawi M, Acharya Y, Hynes N, Tawfick W, et al. Outcomes of Unibody Bifurcated Endograft and Aortobifemoral Bypass for Aortoiliac Occlusive Disease. Vasc Specialist Int. 2020;36(4):216–223. PMID: 33361542 https://doi.org/10.5758/vsi.200051

52. Ahn S, Park KM, Kim YK, Kim JI, Moon IS, Hong KC, et al. Outcomes of endovascular treatment for TASC C and D aorto-iliac lesions. Asian J Surg. 2017;40(3):215–220. PMID: 26787498 https://doi.org/10.1016/j.asjsur.2015.11.006

53. Yuan L, Bao J, Zhao Z, Feng X, Lu Q, Jing Z. Endovascular therapy for long- segment atherosclerotic aortoiliac occlusion. J Vasc Surg. 2014;59(3):663–668. PMID: 24239521 https://doi.org/10.1016/j.jvs.2013.09.005

54. Balzer KM, Weis-Müller BT. Results of open vascular surgical therapy in chronic peripheral arterial disease. Vasa. 2011;40(5):359–367. PMID: 21948778 https://doi.org/10.1024/0301-1526/a000132

55. Ruggiero NJ 2nd, Jaff MR. The current management of aortic, common iliac, and external iliac artery disease: basic data underlying clinical decision making. Ann Vasc Surg. 2011;25(7):990–1003. PMID: 21784611 https://doi.org/10.1016/j.avsg.2011.05.003

56. Oertli D, Waibel P. Die Thrombendarterectomy in aorto-iliac occlusive disease. Schweiz Med Wochenschr. 1995;125(22):1075–1081. German. PMID: 7784869

57. Harris RA, Hardman DT, Fisher C, Lane R, Appleberg M. Aortic reconstructive surgery for limb ischaemia: immediate and long-term follow-up to provide a standard for endovascular procedures. Cardiovasc Surg. 1998;6(3):256–261. PMID: 9705097 https://doi.org/10.1016/s0967-2109(97)00150-6

58. Squizzato F, D’Oria M, Bozza R, Porcellato L, Grego F, Lepidi S. Propensity- Matched Comparison of Endovascular versus Open Reconstruction for TASC-II C/D AortoIliac Occlusive Disease. A TenYear Single-Center Experience with Self- Expanding Covered Stents. Ann Vasc Surg. 2021;71:84–95. PMID: 32927036 https://doi.org/10.1016/j.avsg.2020.08.139