Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy.
Surgery. 2010 Feb;147(2):268-74. doi: 10.1016/j.surg.2009.08.004. Epub 2009 Oct 13.
Only a few operative or interventional studies have addressed the issue of isolated arterial occlusive disease at the femoral bifurcation, the early and late results reportedly being favorable in the former, controversial in the latter. The purpose of this study was to analyze the peri-operative (30-day) and long-term outcomes of isolated surgical endarterectomy in patients with occlusive disease at the common femoral artery (CFA), providing a baseline for comparison with emerging endovascular procedures.
Over an 8-year period, all consecutive patients referred to our institution for claudication, rest pain, nonhealing ulcer(s), or minor tissue loss, with imaging findings of CFA occlusive disease (isolated or with additional infrainguinal lesions in the ipsilateral limb) amenable to endarterectomy of the CFA (isolated or combined with a profundoplasty or with the endarterectomy of the superficial or deep femoral artery first tract, not >1 cm long) were enrolled in the study. We excluded all patients with major tissue loss for which a contemporary infrainguinal revascularization was performed because treating the inflow disease alone would not be sufficient to heal the ischemic wound(s) owing to the presence of concomitant femoral and/or distal lesions, inadequate collateralization, or poor runoff. Descriptive demographic data, risk factors, clinical manifestations, and operative details were recorded. Primary patency (PP), assisted PP (APP), and limb salvage (LS) rates, freedom from additional proximal or distal revascularization in the ipsilateral limb, and survival were assessed using Kaplan-Meier life tables. Univariate and multivariate analyses were performed to identify which factors could influence CFA segment patency or other parameters.
In all, 117 patients were enrolled and underwent 121 CFA endarterectomies, 60.3% for claudication and 39.7% for critical limb ischemia (CLI); 30 patients were excluded because they underwent a contemporary infrainguinal revascularization. All procedures were performed with patients under regional anesthesia and took an average operating time of 1.3 +/- 0.7 hours. There were no perioperative deaths or major complications, but 8 (6.6%) local complications. A complete follow-up (mean 4.2 years) was obtained in 111 patients (115 limbs). The 7-year PP, APP, and LS rates were 96%, 100%, and 100%, respectively; the 7-year rates of freedom from further revascularization and survival were 79% and 80%, respectively.
Operative endarterectomy in patients with claudication or CLI for occlusive CFA disease proved safe, effective, and durable, and should provide a baseline for comparison with endovascular treatment. Proponents of endovascular procedures as a routine alternative treatment option should bear this in mind.
仅有少数手术或介入研究涉及股分叉处孤立性动脉闭塞性疾病，前者的早期和晚期结果报告是有利的，而后者则存在争议。本研究旨在分析股总动脉（CFA）闭塞性疾病患者接受单纯外科内膜切除术的围手术期（30 天）和长期结果，为与新兴的血管内治疗方法进行比较提供基线。
在 8 年期间，所有因跛行、静息痛、未愈合溃疡或小组织损失，并伴有影像学发现股总动脉闭塞性疾病（孤立性或同侧肢体伴有其他下肢动脉病变）而转诊至我院的患者均被纳入研究，这些病变适合行 CFA 内膜切除术（孤立性或结合股深动脉成形术，或首先行股浅动脉或股深动脉第一段内膜切除术，长度不超过 1cm）。我们排除了所有因严重组织损失而接受现代下肢动脉重建的患者，因为由于存在同时的股部和/或远端病变、侧支循环不足或流出道不佳，单纯治疗流入道疾病不足以治愈缺血性创面。记录描述性人口统计学数据、危险因素、临床表现和手术细节。使用 Kaplan-Meier 生命表评估主要通畅率（PP）、辅助通畅率（APP）和肢体存活率（LS）、同侧肢体无进一步近端或远端血运重建、生存情况。进行单因素和多因素分析以确定哪些因素可能影响 CFA 段通畅率或其他参数。
共纳入 117 例患者，共行 121 例 CFA 内膜切除术，60.3%为跛行，39.7%为严重肢体缺血（CLI）；30 例因同期行下肢动脉重建而被排除。所有手术均在区域麻醉下进行，平均手术时间为 1.3±0.7 小时。围手术期无死亡或重大并发症，但有 8 例（6.6%）发生局部并发症。111 例患者（115 条肢体）获得完整随访（平均随访 4.2 年）。7 年的 PP、APP 和 LS 率分别为 96%、100%和 100%；7 年无进一步血运重建和生存的比率分别为 79%和 80%。
对于股总动脉闭塞性疾病引起的跛行或 CLI 患者，手术内膜切除术安全、有效、持久，应为与血管内治疗方法进行比较提供基线。提倡将血管内治疗作为常规替代治疗选择的人应该记住这一点。
