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首页> 外文期刊>Vascular and endovascular surgery >Surgical Interventions for Organ and Limb Ischemia Associated With Primary and Secondary Antiphospholipid Antibody Syndrome With Arterial Involvement
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Surgical Interventions for Organ and Limb Ischemia Associated With Primary and Secondary Antiphospholipid Antibody Syndrome With Arterial Involvement

机译：具有动脉受累的器官和肢体抗磷脂抗体综合征的器官和肢体缺血的外科干预措施

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摘要

Objective: The association of antiphospholipid antibody syndrome (APS) and hypercoagulability is well known. Arterial compromise leading to ischemia of organs and/or limbs in patients with APS is uncommon, frequently unrecognized, and rarely described. We evaluated our institutional experience. Methods: Retrospective review was conducted. From August 2007 to September 2016, 807 patients with diagnosis of APS were managed in our Institution. Patients with primary and secondary APS who required interventions were examined. Demographics, comorbidities, manifestations, procedures, complications, and other factors affecting outcomes were recorded. Results: Fourteen patients (mean age 35 years old, standard deviation ±14) were evaluated and treated by our service. Six (43%) of them had primary APS and 8 (57%) had secondary APS; 11 (79%) were female. Two (14%) experienced distal aorta and iliac arteries involvement, 3 (21%) visceral vessels disease, 2 (14%) in upper and 7 (50%) in the lower extremity vasculatures. Thirteen (93%) patients underwent direct open revascularization and 1 with hand ischemia (Raynaud disease) underwent sympathectomy. During the mean follow-up period of 48 months, reinterventions included a revision of the proximal anastomosis of an aortobifemoral bypass graft, 1 (7%) abdominal exploration for bleeding, 1 (7%) graft thrombectomy, and 4 (29%) amputations (2 below the knee, 1 above the knee, and 1 transmetatarsal). One (7%) death occurred secondary to sepsis in a patient who had acute mesenteric ischemia. Significant differences in clinical manifestations and outcomes were not observed among patients with primary and secondary APS. All patients remained on systemic anticoagulation. Conclusion: APS is a prothrombotic disorder that may lead to arterial involvement with less frequency than the venous circulation but has significant morbidity and limb loss rate. Arterial reconstruction seems feasible in an attempt to salvage organs and limbs; however, research is necessary to establish the optimal anticoagulation regime and long-term management following surgical interventions. ]]>
机译：目的：抗磷脂抗体综合征（APS）和高凝地相容性是众所周知的。导致APS患者患者的缺血和/或肢体缺血的动脉妥协是罕见的，经常无法识别，并且很少描述。我们评估了我们的机构经验。方法：进行回顾性审查。从2007年8月至2016年9月，我们的机构管理了807例诊断APS患者。检查了所需干预的主要和中学AP的患者。记录了人口统计学，合并症，表现，程序，并发症和影响结果的其他因素。结果：我们的服务评估了十四名患者（平均年龄35岁，标准差±14）。其中六（43％）有初级AP，8（57％）有二级APS; 11（79％）是女性。两（14％）经历过远端主动脉和髂动脉受累，3（21％）内脏血管疾病，2（14％）在下肢血管中的上部和7（50％）。十三（93％）患者接受直接开放的血运重建和1次手中的缺血（Raynaud疾病）接受了同情术。在48个月的平均随访期间，重新发明内包括修订主动作用旁路移植物的近端吻合术，1（7％）腹部探测的出血，1（7％）接枝血栓切除术和4（29％）截肢（2下方，膝盖上方1和1个缩小剂）。在患有急性肠系膜缺血的患者中，脓毒症发生了一种（7％）死亡。初级和二级AP的患者中未观察到临床表现和结果的显着差异。所有患者均为全身抗凝。结论：APS是一种普形癌，可能导致频率低于静脉循环但具有显着的发病率和肢体损失率。动脉重建似乎可行，试图挽救器官和肢体;但是，在外科干预措施后，研究是建立最佳的抗凝制度和长期管理的必要条件。 ]]>

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