Fransson T, Thörne J
Kalmar County Hospital, Kalmar, Sweden.
Vasa. 2010 Feb;39(1):59-65. doi: 10.1024/0301-1526/a000006.
This prospective study compares results of infrainguinal revascularisation with autologous vein in diabetic and non-diabetic populations.
101 patients (diabetics (A) n = 50 and non-diabetics (B) n = 51) were operated upon with an in situ saphenous vein bypass to the popliteal artery below knee or to crural arteries, due to critical ischemia. Data on operative details, morbidity, mortality, secondary interventions and graft patency, were collected prospectively. All patients were followed up for 5 years.
The two groups were similar except that diabetics more often suffered from gangrene or tissue loss. The distal anastomoses were constructed significantly more distally in diabetics. There were no differences in perioperative bleeding, length of operation, hospital stay or 30 d mortality. The 5 year patency did not differ significantly between groups, A 68 % vs. B 72 %. The limb salvage was equal in both groups, 86 % after 5 years. Mortality during follow up was significantly higher among diabetics, at two years A 31 % vs. B 14 %.
Distal revascularisation with in situ technique is a durable procedure that can be performed with very good results in both diabetics and non-diabetics. The survival among diabetics is however significantly lower, although reaching 69 % at two years.
本前瞻性研究比较了糖尿病患者和非糖尿病患者下肢动脉重建术中使用自体静脉的效果。
101例患者（糖尿病患者（A组）n = 50例，非糖尿病患者（B组）n = 51例）因严重缺血接受了原位大隐静脉旁路移植术，移植至膝下腘动脉或小腿动脉。前瞻性收集手术细节、发病率、死亡率、二次干预及移植物通畅性等数据。所有患者随访5年。
两组患者情况相似，只是糖尿病患者更常出现坏疽或组织缺失。糖尿病患者的远端吻合口位置明显更靠下。围手术期出血、手术时长、住院时间或30天死亡率无差异。两组5年通畅率无显著差异，A组为68%，B组为72%。两组的肢体挽救率相同，5年后均为86%。随访期间糖尿病患者的死亡率显著更高，两年时A组为31%，B组为14%。
采用原位技术进行远端血管重建是一种持久的手术方法，在糖尿病患者和非糖尿病患者中均可取得良好效果。然而，糖尿病患者的生存率显著更低，尽管两年时可达69%。
