Hickey N C, Thomson I A, Shearman C P, Simms M H
Department of Surgery, Selly Oak Hospital, Birmingham, UK.
Br J Surg. 1991 Dec;78(12):1476-8. doi: 10.1002/bjs.1800781222.
A consecutive series of 315 patients underwent arterial reconstruction for 329 critically ischaemic lower limbs over a 5-year period. Patients were not excluded from limb salvage surgery on the basis of poor run-off on preoperative angiography. Femorocrural bypass to a single calf vessel was required in 239 limbs (73 per cent); the 30-day cumulative mortality rate was 7 per cent, rising to 41 per cent at 5 years. Cumulative graft patency at 30 days, 1 year, 2 years and 5 years was 96, 85, 84 and 82 per cent respectively and was independent of the level of reconstruction. In situ long saphenous vein was the conduit of choice for distal bypass but, when this was absent, satisfactory results were obtained with arm vein or composite vein grafts. Acceptable results can be obtained for reconstructive surgery without preoperative angiographic selection of patients. An aggressive approach to limb salvage is therefore justified.
在5年期间，连续315例患者因329条严重缺血的下肢接受了动脉重建手术。患者不会因术前血管造影显示流出道不佳而被排除在保肢手术之外。239条肢体（73%）需要进行股腘动脉旁路移植至单一小腿血管；30天累积死亡率为7%，5年时升至41%。30天、1年、2年和5年的移植物累积通畅率分别为96%、85%、84%和82%，且与重建水平无关。原位大隐静脉是远端旁路移植的首选管道，但当没有大隐静脉时，使用手臂静脉或复合静脉移植物也能获得满意的结果。在没有对患者进行术前血管造影选择的情况下进行重建手术也能获得可接受的结果。因此，积极的保肢方法是合理的。
