Biancari F, Railo M, Lundin J, Albäck A, Kantonen I, Lehtola A, Lepäntalo M
Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Eur J Vasc Endovasc Surg. 2001 Feb;21(2):137-42. doi: 10.1053/ejvs.2000.1290.
to evaluate the results of redo bypass surgery to the infrapopliteal artery and the value of adjuvant arteriovenous fistula (AVF) in this setting.
retrospective study.
fifty-one redo reconstructions to the infrapopliteal arteries were done for critical leg ischaemia in 45 patients who have had primary infrainguinal reconstructions to the popliteal artery in 20 cases (39%), the crural arteries in 18 (35%), and the pedal arteries in 13 (25%).
a PTFE prosthesis was used in 21 cases (41%). A Miller cuff was used in 16 prosthetic grafts. Adjuvant AVF was added to three autogenous vein and 12 prosthetic grafts.
at 2 years, the primary patency rate was 42%, the secondary patency was 43%, the limb salvage was 67%, the survival was 77%, and 53% of patients were alive with salvaged leg. The primary patency rate with a vein graft was 44% at 1 year, with prosthesis plus AVF 67%, but with prosthesis without AVF only 19%. Secondary patency rates were similar. Prosthetic graft with AVF and those without AVF achieved a 1-year leg salvage rate of 100% and 51%, respectively (p =0.01). Patients with adjuvant AVF had a worse 2-year survival rate that those without AVF (31% vs 89%) (p =0.007; RR: 8.87, CI 95%: 1.62-48.42).
redo bypass surgery using autogenous vein graft may achieve satisfactory long-term results. The use of adjuvant AVF may improve patency of redo infrapopliteal prosthetic bypass grafts.
评估腘下动脉再次搭桥手术的结果以及辅助动静脉内瘘（AVF）在此情况下的价值。
回顾性研究。
对45例严重下肢缺血患者进行了51次腘下动脉再次重建手术，其中20例（39%）曾对腘动脉进行过初次腹股沟下重建，18例（35%）对小腿动脉进行过重建，13例（25%）对足部动脉进行过重建。
21例（41%）使用了聚四氟乙烯（PTFE）假体。16个假体移植物使用了米勒袖套。对3个自体静脉移植物和12个假体移植物添加了辅助AVF。
2年时，原发性通畅率为42%，继发性通畅率为43%，肢体挽救率为67%，生存率为77%，53%的患者存活且肢体得以挽救。静脉移植物1年时的原发性通畅率为44%，假体加AVF为67%，但无AVF的假体仅为19%。继发性通畅率相似。有AVF的假体移植物和无AVF的假体移植物1年时的肢体挽救率分别为100%和51%（p = 0.01）。有辅助AVF的患者2年生存率比无AVF的患者差（31%对89%）（p = 0.007；相对危险度：8.87，95%置信区间：1.62 - 48.42）。
使用自体静脉移植物进行再次搭桥手术可取得满意的长期效果。辅助AVF的使用可能会提高腘下再次假体搭桥移植物的通畅率。
