Zhao Ke-qiang, Zhang Xiao-ming, Shen Chen-yang, Wan Feng
Department of Vascular Surgery, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Wai Ke Za Zhi. 2008 Jun 15;46(12):914-7.
To report the mid- to long-term outcome of artery bypass in chronic ischemia of lower extremities.
The clinical data of 212 patients treated with bypass operation from January 2002 to April 2007 were retrospectively reviewed. Femoropopliteal artery bypass to above-knee popliteal (FP-ak) was carried out in 111 cases, femoropopliteal artery bypass to below-knee popliteal (FP-bk) in 59 cases, aortoiliac bypass in 25 cases and femorofemoral bypass in 17 cases.
One hundred and eighty-six patients (87.7%) were followed up for 6 to 68 months (median, 18 months). One-year primary patency rate of FP-ak and FP-bk was 69.7% and 53.5%, respectively. After graft revision, 1-year secondary patency rate of FP-ak and FP-bk were 81.6% and 60.5%, respectively. The 3-year patency with FP-ak (56.3%) was significantly higher than that in FP-bk (23.8%) (P < 0.05). Fifty-two cases were reoperated on during the follow-up period. Crural or femoral amputation could not avoid in 23 cases (limb salvage rate 89.2%). Ten cases died in 1 to 30 days after the operation, 20 cases died later during followup, and most of them died of cardio-cerebrovascular diseases. Artificial vessel infection occurred in 6 cases.
The selection of surgical treatment for chronic ischemia of lower extremities should based on the ischemic state of the limb. The mid- to long-term patency rate of FP-ak is higher than that of FP-bk.
报告下肢慢性缺血动脉旁路移植术的中长期疗效。
回顾性分析2002年1月至2007年4月行旁路移植术治疗的212例患者的临床资料。其中111例行股腘动脉至腘动脉上段旁路移植术（FP-ak），59例行股腘动脉至腘动脉下段旁路移植术（FP-bk），25例行主髂动脉旁路移植术，17例行股股动脉旁路移植术。
186例患者（87.7%）获得随访，随访时间6至68个月（中位时间18个月）。FP-ak和FP-bk的1年一期通畅率分别为69.7%和53.5%。移植血管翻修后，FP-ak和FP-bk的1年二期通畅率分别为81.6%和60.5%。FP-ak的3年通畅率（56.3%）显著高于FP-bk（23.8%）（P<0.05）。随访期间52例再次手术。23例不可避免地行小腿或大腿截肢术（保肢率89.2%）。10例术后1至30天死亡，20例随访后期死亡，多数死于心脑血管疾病。人工血管感染6例。
下肢慢性缺血手术治疗方式的选择应基于肢体缺血状态。FP-ak的中长期通畅率高于FP-bk。
