Jämsén T, Tulla H, Manninen H, Räisänen H, Lahtinen S, Aittola V, Jaakkola P
Department of Clinical Radiology, Kuopio University Hospital, Finland.
Ann Chir Gynaecol. 2001;90(2):92-9.
The purpose of this clinical study was to assess the success of infrainguinal revascularization in the treatment of lower limb ischaemia.
226 consecutive patients underwent 263 femoropopliteal (n = 194) or femorodistal (n = 69) bypass operations during 1988-1996 at a university hospital. Records of all patients were reviewed. Late control visits including clinical and colour doppler ultrasound examinations were programmed for 109 patients. Initial success, primary and secondary patencies, limb salvage and survival rates were determined and factors affecting outcome were analysed in various patient categories.
Initial success rate was 92% (243/263). The primary and secondary patencies were 70/83% and 52/63% at one and five years, respectively. The corresponding limb salvage rates for patients with chronic critical ischaemia were 82% and 77%. The number of diseased vessels in the treated limb correlated negatively with the primary patency. Advanced age did not affect primary patency or limb salvage rates. Diabetes and the use of distal revascularizations were independent predictors of poorer limb salvage. Diabetes and renal insufficiency proved to shorten life expectancy.
Infrainguinal revascularizations are effective regardless of patient's age. The extent of atherosclerotic changes in the operated limb, diabetes and renal insufficiency are factors affecting outcome.
本临床研究旨在评估下肢缺血性疾病行股腘以下血管重建术的成功率。
1988年至1996年期间，一所大学医院连续226例患者接受了263次股腘（n = 194）或股远端（n = 69）旁路手术。对所有患者的记录进行了回顾。为109例患者安排了包括临床和彩色多普勒超声检查在内 的后期随访。确定了初始成功率、一期和二期通畅率、肢体挽救率和生存率，并分析了不同患者类别中影响预后的因素。
初始成功率为92%（243/263）。一期和五年时的一期和二期通畅率分别为70/83%和52/63%。慢性严重缺血患者相应的肢体挽救率分别为82%和77%。治疗肢体中病变血管的数量与一期通畅率呈负相关。高龄不影响一期通畅率或肢体挽救率。糖尿病和远端血管重建术的应用是肢体挽救效果较差的独立预测因素。糖尿病和肾功能不全被证明会缩短预期寿命。
无论患者年龄如何，股腘以下血管重建术都是有效的。手术肢体动脉粥样硬化改变的程度、糖尿病和肾功能不全是影响预后的因素。
