Schneider P A, Ogawa D Y, Rush M P
Division of Vascular Surgery and Vascular Noninvasive Laboratory, Kaiser Medical Center, Honolulu 96819, HI, USA.
Cardiovasc Surg. 1999 Dec;7(7):699-703. doi: 10.1016/s0967-2109(98)00143-4.
This study prospectively assessed the results of lower extremity surgical revascularization, which was performed on the basis of duplex arterial mapping in selected patients without preoperative contrast arteriography. Criteria were developed for patient selection. Among 158 patients requiring surgery for lower extremity ischemia over a 24-month period, 24 (15%) were selected for operation without current preoperative arteriography. Aorto-iliac and infrainguinal duplex arterial mapping were performed in an laboratory that was accredited by the Intersocietal Commission for Accreditation of Vascular Laboratories. Indications for surgery were minor gangrene (11), rest pain (7), or claudication (6). Operations included femoropopliteal bypass (14), femoral endarterectomy (9) and femoral-femoral bypass (1). Mean length of stay was 4.5 +/- 2.0 days. Ankle-brachial index improved from 0.49 +/- 0.12 to 0.80 +/- 0.15 (P < 0.05). Primary patency was 91.7 +/- 9.4% and assisted primary patency was 100% at 18 months. There was no graft occlusion or limb loss. Mean follow-up was 16.7 +/- 7.0 months. These preliminary data support the safety and durability of duplex-guided lower extremity surgical revascularization without arteriography in selected cases. Success in a broader application of this approach requires the continuing development of patient selection criteria.
本研究前瞻性评估了下肢外科血管重建术的结果，该手术是在选定的未进行术前造影动脉造影的患者中基于双功动脉成像进行的。制定了患者选择标准。在24个月期间需要进行下肢缺血手术的158例患者中，24例（15%）在未进行当前术前动脉造影的情况下被选进行手术。腹主动脉-髂动脉和腹股沟下双功动脉成像在一个获得血管实验室认证协会认可的实验室中进行。手术指征为轻度坏疽（11例）、静息痛（7例）或间歇性跛行（6例）。手术包括股腘动脉搭桥术（14例）、股动脉内膜切除术（9例）和股-股动脉搭桥术（1例）。平均住院时间为4.5±2.0天。踝肱指数从0.49±0.12提高到0.80±0.15（P<0.05）。18个月时，一期通畅率为91.7±9.4%，辅助一期通畅率为100%。没有移植物闭塞或肢体丢失。平均随访时间为16.7±7.0个月。这些初步数据支持了在选定病例中无需动脉造影的双功引导下肢外科血管重建术的安全性和耐久性。这种方法在更广泛应用中的成功需要不断完善患者选择标准。
