人工流入道移植物患者自体股腘动脉旁路移植闭塞的危险因素。

Risk factors for autogenous infrainguinal bypass occlusion in patients with prosthetic inflow grafts.

作者信息

Lam Everett Y, Landry Gregory J, Edwards James M, Yeager Richard A, Taylor Lloyd M, Moneta Gregory L

机构信息

Division of Vascular Surgery, Oregon Health & Science University, Portland, OR 97239-3098, USA.

出版信息

J Vasc Surg. 2004 Feb;39(2):336-42. doi: 10.1016/j.jvs.2003.09.031.

DOI:10.1016/j.jvs.2003.09.031

PMID:14743133

Abstract

OBJECTIVE

In patients with prosthetic inflow (PI) grafts the proximal anastomosis of autogenous infrainguinal bypass (AIB) can be placed on the PI or on a distal native vessel in the groin. This study was performed to determine the effect of placement of an AIB proximal anastomotic site in a patient with ipsilateral PI.

METHODS

Patients undergoing AIB and PI between January 1990 and July 2002 were included in the study. They were classified into two groups on the basis of location of the proximal anastomosis. In group 1 the AIB proximal anastomosis was placed on the PI in the groin, whereas in group 2 the AIB proximal anastomosis was placed on a distal native groin artery. Patency, limb salvage, and patient survival in the two groups were calculated with the Kaplan-Meier method. The Cox proportional hazards model was used to determine independent risk factors affecting AIB patency.

RESULTS

Two hundred twenty-nine patients underwent AIB and PI. In group 1, 23 AIBs became thrombosed concurrent with 26 PI occlusions, and in group 2, 7 AIBs became thrombosed concurrent with 36 PI occlusions (P <.001). Five-year assisted primary patency, limb salvage, and patient survival in groups 1 and 2 were 50% and 75% (P <.001, log-rank test), 78% and 90% (P =.005, log-rank test), and 56% and 69% (P = NS, log-rank test), respectively. Factors independently associated with AIB occlusion are hypertension (hazard ratio [HR], 3.41; 95% confidence interval [CI], 1.65-7.05; P =.001), postoperative warfarin sodium therapy (HR, 1.86; 95% CI, 1.07-3.23; P =.03), continued smoking (HR, 1.72; 95% CI, 0.93-3.18; P =.08), AIB arising from PI (HR, 2.38; 95% CI, 1.35-4.18; P =.003), and PI occlusion (HR, 3.70; 95% CI, 2.15-6.36; P <.001).

CONCLUSION

A proximal AIB anastomosis located directly on the PI is an independent risk factor for decreased AIB patency of equal or greater importance than current smoking, hypertension, or PI occlusion. The proximal anastomosis of an AIB in a patient with an ipsilateral PI should be placed on a distal native artery.

摘要

目的

在使用人工流入（PI）移植物的患者中，自体股下旁路移植术（AIB）的近端吻合口可置于PI上或腹股沟区的远端自体血管上。本研究旨在确定同侧PI患者中AIB近端吻合口位置的影响。

方法

纳入1990年1月至2002年7月期间接受AIB和PI的患者。根据近端吻合口的位置将他们分为两组。在第1组中，AIB近端吻合口置于腹股沟区的PI上，而在第2组中，AIB近端吻合口置于腹股沟区远端的自体动脉上。采用Kaplan-Meier法计算两组的通畅率、肢体挽救率和患者生存率。使用Cox比例风险模型确定影响AIB通畅的独立危险因素。

结果

229例患者接受了AIB和PI。在第1组中，23例AIB发生血栓形成，同时26例PI闭塞；在第2组中，7例AIB发生血栓形成，同时36例PI闭塞（P<.001）。第1组和第2组的5年辅助原发性通畅率、肢体挽救率和患者生存率分别为50%和75%（P<.001，对数秩检验）、78%和90%（P=.005，对数秩检验）以及56%和69%（P=无显著性差异，对数秩检验）。与AIB闭塞独立相关的因素包括高血压（风险比[HR]，3.41；95%置信区间[CI]，1.65 - 7.05；P=.001）、术后华法林钠治疗（HR，1.86；95%CI，1.07 - 3.23；P=.03）、持续吸烟（HR，1.72；95%CI，0.93 - 3.18；P=.08）、源自PI的AIB（HR，2.38；95%CI，1.35 - 4.18；P=.003）以及PI闭塞（HR，3.70；95%CI，2.15 - 6.36；P<.001）。