对于严重肢体缺血患者，旋切术是肢体挽救的最佳一线治疗方法吗？
Is atherectomy the best first-line therapy for limb salvage in patients with critical limb ischemia?
作者信息
Loor Gabriel, Skelly Christopher L, Wahlgren Carl-Magnus, Bassiouny Hisham S, Piano Giancarlo, Shaalan Wael, Desai Tina R
机构信息
Department of Vascular Surgery, University of Chicago, Chicago, Illinois, USA.
出版信息
Vasc Endovascular Surg. 2009 Dec;43(6):542-50. doi: 10.1177/1538574409334825. Epub 2009 Jul 29.
OBJECTIVE
To determine the efficacy of atherectomy for limb salvage compared with open bypass in patients with critical limb ischemia.
METHODS
Ninety-nine consecutive bypass and atherectomy procedures performed for critical limb ischemia between January 2003 and October 2006 were reviewed.
RESULTS
A total of 99 cases involving TASC C (n = 43, 44%) and D (n = 56, 56%) lesions were treated with surgical bypass in 59 patients and atherectomy in 33 patients. Bypass and atherectomy achieved similar 1-year primary patency (64% vs 63%; P = .2). However, the 1-year limb salvage rate was greater in the bypass group (87% vs 69%; P = .004). In the tissue loss subgroup, there was a greater limb salvage rate for bypass patients versus atherectomy (79% vs 60%; P = .04).
CONCLUSIONS
Patients with critical limb ischemia may do better with open bypass compared with atherectomy as first-line therapy for limb salvage.
目的
确定在严重肢体缺血患者中，与开放旁路手术相比，旋切术在保肢方面的疗效。
方法
回顾了2003年1月至2006年10月期间为严重肢体缺血进行的99例连续旁路手术和旋切术。
结果
共有99例涉及TASC C（n = 43，44%）和D（n = 56，56%）病变的患者接受治疗，其中59例行手术旁路，33例行旋切术。旁路手术和旋切术的1年主要通畅率相似（64%对63%；P = 0.2）。然而，旁路手术组的1年保肢率更高（87%对69%；P = 0.004）。在组织缺损亚组中，旁路手术患者的保肢率高于旋切术患者（79%对60%；P = 0.04）。
结论
对于严重肢体缺血患者，作为保肢的一线治疗方法，开放旁路手术可能比旋切术效果更好。
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