股浅动脉长段闭塞的远端动脉内膜切除术与膝上旁路手术对比：一项随机对照试验的中期结果（REVAS试验）
Remote endarterectomy versus supragenicular bypass surgery for long occlusions of the superficial femoral artery: medium-term results of a randomized controlled trial (the REVAS trial).
作者信息
Gisbertz Suzanne S, Tutein Nolthenius Rudolf P, de Borst Gert Jan, van der Laan Lyckle, Overtoom Tim Th C, Moll Frans L, de Vries Jean-Paul P M
机构信息
Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
出版信息
Ann Vasc Surg. 2010 Nov;24(8):1015-23. doi: 10.1016/j.avsg.2010.03.022.
BACKGROUND
To investigate the optimal surgical treatment, remote superficial femoral artery endarterectomy (RSFAE) or supragenicular bypass, for Transatlantic Inter-Society Consensus (TASC) C and D lesions of the superficial femoral artery. Medium-term results will be presented.
METHODS
The study randomized 116 patients, 61 to RSFAE and 55 to supragenicular bypass surgery. Indications for surgery were claudication in 77, rest pain in 21, or tissue loss in 18.
RESULTS
Primary patency after 3 years of follow-up was 47% for RSFAE and 60% for bypass (p = 0.107), assisted primary patency was 63 and 69% (p = 0.406), and secondary patency was 69 and 73% (p = 0.541), respectively. For venous (n = 25) and prosthetic grafts (n = 30) at 3-year follow-up, primary patency was 65% and 56 versus 47% for RSFAE (p = 0.143), assisted primary patency was 84% and 56 versus 63% for RSFAE (p = 0.052), and secondary patency was 89% and 59 versus 69% for RSFAE (p = 0.046), respectively. Limb salvage was 97% after RSFAE and 95% after bypass surgery (p = 0.564).
CONCLUSION
RSFAE is a minimally invasive option for surgical repair of TASC C and D superficial femoral artery obstructions, with assisted primary and secondary patency rates comparable with bypass surgery. Venous bypass grafting is superior to both RSFAE and polytetrafluoroethylene grafting, but only 45% of patients had a sufficient saphenous vein available. If the saphenous vein is not applicable, RSFAE should be considered because it is less invasive and prosthetic graft material can be avoided.
背景
探讨针对股浅动脉跨大西洋两岸多学会共识（TASC）C 型和 D 型病变的最佳手术治疗方法，即远端股浅动脉内膜切除术（RSFAE）或膝上旁路移植术。将展示中期结果。
方法
该研究将 116 例患者随机分组，61 例行 RSFAE，55 例行膝上旁路移植手术。手术指征为 77 例间歇性跛行、21 例静息痛或 18 例组织缺损。
结果
随访 3 年后，RSFAE 的一期通畅率为 47%，旁路移植术为 60%（p = 0.107）；辅助一期通畅率分别为 63%和 69%（p = 0.406）；二期通畅率分别为 69%和 73%（p = 0.541）。在 3 年随访时，对于静脉移植物（n = 25）和人工血管移植物（n = 30），一期通畅率分别为 65%和 56%，而 RSFAE 为 47%（p = 0.143）；辅助一期通畅率分别为 84%和 56%，而 RSFAE 为 63%（p = 0.052）；二期通畅率分别为 89%和 59%，而 RSFAE 为 69%（p = 0.046）。RSFAE 术后肢体挽救率为 97%，旁路移植手术后为 95%（p = 0.564）。
结论
RSFAE 是手术修复 TASC C 型和 D 型股浅动脉阻塞的微创选择，其辅助一期和二期通畅率与旁路移植手术相当。静脉旁路移植术优于 RSFAE 和聚四氟乙烯移植术，但只有 45%的患者有足够的大隐静脉可用。如果大隐静脉不可用，应考虑 RSFAE，因为其侵入性较小且可避免使用人工血管材料。
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