Appleton N D, Bosanquet D, Morris-Stiff G, Ahmed H, Sanjay P, Lewis M H
Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK.
Ann R Coll Surg Engl. 2010 Sep;92(6):499-502. doi: 10.1308/003588410X12664192076890. Epub 2010 Jun 1.
Extra-anatomical bypass grafting is a recognised method of lower limb re-vascularisation in high-risk patients who cannot tolerate aortic cross clamping, or in those with a hostile abdomen. We present a single surgeon series of such procedures and determine relevant outcomes.
A retrospective review was performed on a prospectively maintained database of patients undergoing femoro-femoral or axillo-femoral bypass surgery between 1986 and 2004.
Patency rates for femoral (n = 28; 32%) versus axillary (n = 59; 68%) bypass procedures at 1 month, 1, 3 and 5 years were (92% vs 93%), (69% vs 85%), (60% vs 72%) and (55% vs 67%), respectively. Patient survival rates for the corresponding procedures and time intervals were (96% vs 90%), (96% vs 67%), (85% vs 45%) and (73% vs 38%) and revealed a significantly lower survival rate in those undergoing axillary procedures (P = 0.002). Limb salvage rates were calculated at (100% vs 91%), (96% vs 84%), (96% vs 81%) and (92% vs 81%) with no statistically significant difference found between the two groups (P = 0.124). Two-thirds of the patients who required major amputation died within 12 months of surgery.
Acceptable 30-day morbidity, long-term primary patency and survival rates are obtainable in patients suitable for extra-anatomical bypass surgery despite having significant co-morbidities. We have shown 5-year patency rates in those that survive axillary procedures to be as good as those undergoing femoral procedures. Furthermore, surviving patients who evade amputation within a year have an excellent chance of long-term limb salvage.
解剖外旁路移植术是一种公认的下肢血管重建方法，适用于无法耐受主动脉交叉钳夹的高危患者或腹部情况不佳的患者。我们展示了一位外科医生开展的此类手术系列病例，并确定了相关结果。
对1986年至2004年间接受股-股或腋-股旁路手术患者的前瞻性维护数据库进行回顾性分析。
股旁路手术（n = 28；32%）与腋旁路手术（n = 59；68%）在1个月、1年、3年和5年时的通畅率分别为（92%对93%）、（69%对85%）、（60%对72%）和（55%对67%）。相应手术和时间间隔的患者生存率分别为（96%对90%）、（96%对67%）、（85%对45%）和（73%对38%），结果显示接受腋旁路手术的患者生存率显著较低（P = 0.002）。肢体挽救率分别为（100%对91%）、（96%对84%）、（96%对81%）和（92%对81%），两组之间未发现统计学显著差异（P = 0.124）。三分之二需要进行大截肢的患者在术后12个月内死亡。
适合解剖外旁路手术的患者，尽管存在严重合并症，但仍可获得可接受的30天发病率、长期原发性通畅率和生存率。我们已表明，接受腋旁路手术存活患者的5年通畅率与接受股旁路手术的患者相当。此外，在一年内避免截肢的存活患者有极好的长期肢体挽救机会。
