Roddy Sean P, Darling R Clement, Maharaj Dale, Chang Benjamin B, Paty Philip S k, Kreienberg Paul B, Lloyd William E, Ozsvath Kathleen, Shah Dhiraj M
Institute for Vascular Health and Disease, Albany Medical College., albany, NY 12208, USA.
J Vasc Surg. 2003 Feb;37(2):399-402. doi: 10.1067/mva.2003.99.
Few will debate that infrainguinal arterial reconstruction increases limb salvage. However, numerous reports describe a difference in results in coronary and peripheral arterial reconstructions between men and women. In this study, we analyze the outcome of infrainguinal bypasses performed over 30 years and stratify the results by gender.
We reviewed our vascular registry from 1968 to 1999 for all infrainguinal arterial reconstructions. Demographics, indications, and adverse outcomes were analyzed. Patency, limb salvage, and survival rates were determined with life-table analysis. The chi2, log-rank, and Student t tests were used to determine statistical significance.
Five thousand eight hundred eighty procedures were performed, with 2161 in women (37%). Women were significantly older (71 versus 66 years), more often diabetic (53% versus 50%), and less often smokers (27% versus 44%) and more often had surgery for limb salvage (89.8% versus 81.0%). Mortality, complications, and need for revision did not differ. Primary patency rate was 44% versus 47%, secondary patency rate was 55% versus 58%, and survival rate was 39% versus 34% in men and women, respectively, at 10 years (all P >.05). Limb salvage rate in women exceeded that in men (93% versus 88%) at 10 years. Subgroup analysis by conduit also revealed no difference in patency.
Infrainguinal arterial reconstruction can be performed safely with comparable results in women and men. Although women may present older and more often for limb salvage, outcomes do not appear to be adversely affected.
几乎没有人会质疑股下动脉重建术能提高肢体挽救率。然而，大量报告描述了男性和女性在冠状动脉和外周动脉重建结果上的差异。在本研究中，我们分析了30年来股下旁路手术的结果，并按性别对结果进行分层。
我们回顾了1968年至1999年血管登记处所有股下动脉重建手术的资料。分析了人口统计学、手术指征和不良结局。采用寿命表分析法确定通畅率、肢体挽救率和生存率。使用卡方检验、对数秩检验和学生t检验来确定统计学意义。
共进行了5880例手术，其中女性2161例（37%）。女性年龄显著更大（71岁对66岁），糖尿病患者更多（53%对50%），吸烟者更少（27%对44%），因肢体挽救而接受手术的情况更常见（89.8%对81.0%）。死亡率、并发症和翻修需求无差异。10年时，男性和女性的一期通畅率分别为44%对47%，二期通畅率分别为55%对58%，生存率分别为39%对34%（所有P>.05）。10年时女性的肢体挽救率超过男性（93%对88%）。按血管移植物进行的亚组分析也显示通畅率无差异。
股下动脉重建术在女性和男性中均可安全进行，结果相当。尽管女性可能年龄更大，且更多是为了挽救肢体而进行手术，但结局似乎未受到不利影响。
