Demirel Serdar, Winter Christof, Bruijnen Hans, Böckler Dittmar, Attigah Nicolas, Gamstätter Gerhard
Department of Vascular and Endovascular Surgery, University Hospital of Ruprecht-Karls, Heidelberg, Germany.
Ann Vasc Surg. 2010 Nov;24(8):1024-33. doi: 10.1016/j.avsg.2010.06.002.
To investigate whether prior staged percutaneous transluminal angioplasty of the femoro-popliteal segment influences long-term results of distal bypass grafts.
Between October 1987 and January 2009, 261 distal origin grafts for critical limb ischemia were performed at a single institution. A total of 223 grafts had angiographic no inflow lesions (-PA-group). Additionally, 38 grafts were performed staged within 30 days after percutaneous femoro-popliteal angioplasty (+PA-group) because of 28 TASC A (73%) and 10 TASC B (27%) lesions. Postoperative graft surveillance was performed at 3, 6, 12, and 18 months, then annually thereafter. Treatment groups were compared with Kaplan-Meier analysis.
Follow-up ranged from 1 to 198 months (median, 34 months). The 5-year primary patency was 73% for the +PA-group and 62% for the -PA-group (p = 0.20). Assisted primary patency for the +PA-group at 5 years was 80% and for the -PA-group was 70% (p = 0.17). The corresponding secondary patency at 5 years was 84% for the +PA-group and 71% for the -PA-group (p = 0.12), respectively. Limb salvage and amputation free survival at 5 years were 84% and 46% for the +PA-group, and 81% and 37% for the -PA-group, respectively (p = 0.57, 0.92). Bypass-threatening stenosis of the inflow-vessel was detected for four (10.5%) cases in the +PA-group and for 21 (8%) in the -PA-group.
Long-term results of distal origin grafts performed after femoro-popliteal angioplasty because of TASC A and B lesions are comparable with those observed in distal origin grafts without proximal stenosis. Distal origin bypass grafting is not compromised by prior endovascular treatment of the inflow-vessel.
探讨股腘段预先分期经皮腔内血管成形术是否会影响远端旁路移植术的长期效果。
1987年10月至2009年1月期间，在单一机构进行了261例用于治疗严重肢体缺血的远端起源移植术。共有223例移植术存在血管造影显示的无流入道病变（-PA组）。另外，由于28例TASC A（73%）和10例TASC B（27%）病变，38例移植术在经皮股腘血管成形术后30天内进行了分期手术（+PA组）。术后分别在3、6、12和18个月进行移植血管监测，此后每年监测一次。采用Kaplan-Meier分析对治疗组进行比较。
随访时间为1至198个月（中位数为34个月）。+PA组5年的原发性通畅率为73%，-PA组为62%（p = 0.20）。+PA组5年的辅助原发性通畅率为80%，-PA组为70%（p = 0.17）。相应地，+PA组和-PA组5年的继发性通畅率分别为84%和71%（p = 0.12）。+PA组和-PA组5年的肢体挽救率和无截肢生存率分别为84%和46%，以及81%和37%（p = 0.57，0.92）。+PA组有4例（10.5%）检测到流入血管存在威胁旁路移植的狭窄，-PA组有21例（8%）。
因TASC A和B病变在股腘血管成形术后进行的远端起源移植术的长期效果与未出现近端狭窄的远端起源移植术的效果相当。流入血管先前的血管内治疗不会影响远端起源旁路移植术。
