Martin D, Katz S G
Department of Surgery, Huntington Memorial Hospital, Pasadena, Division of Vascular Surgery, University of Southern California School of Medicine, Pasadena, California, USA.
Am J Surg. 2000 Aug;180(2):100-3. doi: 10.1016/s0002-9610(00)00426-8.
Although aortoiliac disease remains a common cause of lower extremity ischemia, the efficacy of axillofemoral bypass in this setting remains controversial. This report summarizes our institutional experience with axillofemoral bypass.
A retrospective review of consecutive axillofemoral bypass grafts was performed at a single institution between 1984 and 1997. Only patients presenting with chronic aortoiliac occlusive disease were included. Patient demographics, risk factors, indications for surgery and outcomes were recorded. Survival curves for primary patency were plotted using the Kaplan-Meier method according to the standards set by the Society of Vascular Surgery-International Society for Cardiovascular Surgery. Comparisons between groups were made using the log rank method. Statistical significance was assumed at P values <0.05.
Sixty patients underwent axillofemoral bypass grafting of which 53 were bifemoral and 8 unifemoral. Forty-seven procedures were performed for limb salvage. Primary patency rates at 1, 3, and 5 years were 86%, 72%, and 63%, respectively. Thirty-day mortality rate was 4.9%. Sixty percent of graft occlusions occurred in the femorofemoral limb with continued patency of the axillofemoral limb. Risk factors, type of procedure and superficial femoral artery patency had no statistically significant effect on long-term patency.
In the setting of diffuse, chronic aortoiliac occlusive disease, long-term patency rates of axillofemoral grafts approach those of aortobifemoral bypass and exceed those quoted for percutaneous transluminal angioplasty, with results that are highly reproducible. Axillofemoral bypass is an excellent option in those patients at prohibitive risk for direct aortic reconstruction or those with limited life expectancy.
尽管主髂动脉疾病仍是下肢缺血的常见原因，但腋股旁路术在此情况下的疗效仍存在争议。本报告总结了我们机构开展腋股旁路术的经验。
对1984年至1997年间在单一机构连续进行的腋股旁路移植术进行回顾性研究。仅纳入患有慢性主髂动脉闭塞性疾病的患者。记录患者的人口统计学资料、危险因素、手术指征及结果。根据血管外科学会-国际心血管外科学会制定的标准，采用Kaplan-Meier方法绘制原发性通畅率的生存曲线。组间比较采用对数秩检验。P值<0.05时认为具有统计学意义。
60例患者接受了腋股旁路移植术，其中53例为双侧股动脉搭桥，8例为单侧股动脉搭桥。47例手术是为了挽救肢体。1年、3年和5年的原发性通畅率分别为86%、72%和63%。30天死亡率为4.9%。60%的移植血管闭塞发生在股-股肢体，而腋-股肢体仍保持通畅。危险因素、手术类型和股浅动脉通畅情况对长期通畅率无统计学显著影响。
在弥漫性慢性主髂动脉闭塞性疾病的情况下，腋股移植血管的长期通畅率接近主双股旁路术，且超过经皮腔内血管成形术的报道，结果具有高度可重复性。对于直接主动脉重建风险过高或预期寿命有限的患者，腋股旁路术是一个极佳的选择。
