Berceli S A, Chan A K, Pomposelli F B, Gibbons G W, Campbell D R, Akbari C M, Brophy D T, LoGerfo F W
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
J Vasc Surg. 1999 Sep;30(3):499-508. doi: 10.1016/s0741-5214(99)70077-7.
Although pedal artery bypass has been established as an effective and durable limb salvage procedure, the utility of these bypass grafts in limb salvage, specifically for the difficult problem of heel ulceration, remains undefined.
We retrospectively reviewed 432 pedal bypass grafts placed for indications of ischemic gangrene or ulceration isolated to either the forefoot (n = 336) or heel (n = 96). Lesion-healing rates and life-table analysis of survival, patency, and limb salvage were compared for forefoot versus heel lesions. Preoperative angiograms were reviewed to evaluate the influence of an intact pedal arch on heel lesion healing.
Complete healing rates for forefoot and heel lesions were similar (90.5% vs 86.5%, P =.26), with comparable rates of major lower extremity amputation (9.8% vs 9.3%, P =.87). Time to complete healing in the heel lesion group ranged from 13 to 716 days, with a mean of 139 days. Preoperative angiography demonstrated an intact pedal arch in 48.8% of the patients with heel lesions. Healing and graft patency rates in these patients with heel lesions were independent of the presence of an intact arch, with healing rates of 90.2% and 83.7% (P =.38) and 2-year patency rates of 73.4% and 67.0% in complete and incomplete pedal arches, respectively. Comparison of 5-year primary and secondary patency rates between the forefoot and heel lesion groups were essentially identical, with primary rates of 56.9% versus 62.1% (P =.57) and secondary rates of 67.2% versus 60.3% (P =.50), respectively.
Bypass grafts to the dorsalis pedis artery provide substantial perfusion to the posterior foot such that the resulting limb salvage and healing rates for revascularized heel lesions is excellent and comparable with those observed for ischemic forefoot pathology.
尽管足背动脉旁路移植术已被确立为一种有效且持久的肢体挽救手术，但这些旁路移植术在肢体挽救中的效用，特别是对于足跟溃疡这一难题，仍不明确。
我们回顾性分析了432例因缺血性坏疽或溃疡而进行的足背旁路移植术，这些病变局限于前足（n = 336）或足跟（n = 96）。比较了前足与足跟病变的愈合率以及生存、通畅和肢体挽救的生命表分析。回顾术前血管造影以评估完整足弓对足跟病变愈合的影响。
前足和足跟病变的完全愈合率相似（90.5%对86.5%，P = 0.26），下肢大截肢率相当（9.8%对9.3%，P = 0.87）。足跟病变组完全愈合的时间为13至716天，平均为139天。术前血管造影显示，48.8%的足跟病变患者足弓完整。这些足跟病变患者的愈合和移植通畅率与足弓是否完整无关，足弓完整和不完整的患者愈合率分别为90.2%和83.7%（P = 0.38），2年通畅率分别为73.4%和67.0%。前足和足跟病变组5年的初次和二次通畅率比较基本相同，初次通畅率分别为56.9%对62.1%（P = 0.57），二次通畅率分别为67.2%对60.3%（P = 0.50）。
足背动脉旁路移植术可为后足提供充足的灌注，使得血管重建后足跟病变的肢体挽救和愈合率极佳，与缺血性前足病变的情况相当。
