Pedersen G, Laxdal E, Aune S
Department of Vascular Surgery, Haukeland University Hospital, N-5021 Bergen, Norway.
Eur J Vasc Endovasc Surg. 2006 Dec;32(6):680-5. doi: 10.1016/j.ejvs.2006.06.015. Epub 2006 Aug 28.
To investigate the impact of patient characteristics and treatment modality (graft thrombectomy vs thrombolysis) on the results of redo procedures for occluded above-knee prosthetic femoropopliteal grafts implanted for critical ischaemia.
Fifty-five procedures (thrombolysis 24 and thrombectomy 31) were performed on 24 prostheses (23 patients, 24 limbs) between January 1990 and December 2001. All cases were prospectively registered. Graft patency, limb salvage and survival rates were studied and subgroups of patients were compared. Risk factors were analysed with the use of log rank test and Cox proportional hazard analysis.
Half of the 24 initial procedures to restored patency failed within one month. The outcome of second- or third-time redo procedures was similar. The primary patency rates of all 55 redo procedures were 32% at three months, 28% at six months and 12% at 12 months. The results of thrombectomy and thrombolysis were similar. Re-opened grafts additionally treated for an underlying anastomotic stenosis had significantly better patency as compared with re-opened grafts without a pre-existing stenosis on both univariate analysis (p = 0.024) and multivariate analysis (p = 0.027, hazard ratio 2.813). The one-year limb salvage rate was 76%. The one- and five-year survival rates were 87% and 52%, respectively.
The results of redo procedures for occluded above-knee prosthetic grafts were disappointing. Grafts in which a graft-related stenosis was treated performed better than grafts in which occlusion could not be attributed to an underlying stenosis. Such cases should most likely be offered conservative treatment, amputation or a new arterial reconstruction.
研究患者特征和治疗方式（移植物血栓切除术与溶栓术）对因严重缺血而植入的膝上人工股腘动脉移植物闭塞后再次手术结果的影响。
1990年1月至2001年12月期间，对24个假体（23例患者，24条肢体）进行了55次手术（溶栓术24例，血栓切除术31例）。所有病例均进行前瞻性登记。研究移植物通畅率、肢体挽救率和生存率，并比较患者亚组。使用对数秩检验和Cox比例风险分析对危险因素进行分析。
24例最初恢复通畅的手术中有一半在1个月内失败。第二次或第三次再次手术的结果相似。55次再次手术的三个月主要通畅率为32%，六个月为28%，十二个月为12%。血栓切除术和溶栓术的结果相似。在单因素分析（p = 0.024）和多因素分析（p = 0.027，风险比2.813）中，因潜在吻合口狭窄而接受额外治疗的再通移植物的通畅率明显高于无既往狭窄的再通移植物。一年肢体挽救率为76%。一年和五年生存率分别为87%和52%。
膝上人工移植物闭塞后再次手术的结果令人失望。治疗与移植物相关狭窄的移植物比闭塞不能归因于潜在狭窄的移植物表现更好。此类病例很可能应给予保守治疗、截肢或新的动脉重建。
