Schamp Katja B C, Meerwaldt Robbert, Reijnen Michel M P J, Geelkerken Robert H, Zeebregts Clark J
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Ann Vasc Surg. 2012 Nov;26(8):1145-53. doi: 10.1016/j.avsg.2012.02.006. Epub 2012 Jul 25.
Critical limb ischemia (CLI) represents the extreme of the peripheral arterial occlusive disease spectrum and is associated with high mortality. Limb salvage often requires infrapopliteal revascularization by either angioplasty or bypass surgery. The past decade has witnessed a paradigm shift in CLI management toward endovascular treatment. This narrative review describes the clinical outcome, treatment strategy, and limitations of both modalities.
A literature search was performed of the PubMed and Cochrane databases. All articles, published until September 2011, describing treatment by infrapopliteal arterial revascularization were included.
Angioplasty and bypass surgery are both related to a limb salvage rate of approximately 80% at 3-year follow-up. Patency rates appear to be higher after surgery. A reliable comparison of the two modalities, however, is complicated by various confounders, including patient selection, lesion characteristics, and complication rates. Additionally, most studies did not describe the standard use of best medical treatment or outcome for relief of ischemic pain, wound healing, or functional improvement.
Infrapopliteal angioplasty and bypass surgery both provide an acceptable limb salvage rate, but patency appears to be better after bypass surgery. Both modalities are likely to be complementary. Additional randomized trials are indicated to provide a treatment algorithm for patients with CLI and infrapopliteal arterial occlusive disease.
严重肢体缺血（CLI）是外周动脉闭塞性疾病谱中的极端情况，与高死亡率相关。肢体挽救通常需要通过血管成形术或搭桥手术进行腘下血管重建。在过去十年中，CLI的治疗模式已向血管内治疗转变。这篇叙述性综述描述了这两种治疗方式的临床结果、治疗策略及局限性。
对PubMed和Cochrane数据库进行文献检索。纳入所有截至2011年9月发表的描述腘下动脉血管重建治疗的文章。
在3年随访时，血管成形术和搭桥手术的肢体挽救率均约为80%。手术后的通畅率似乎更高。然而，由于包括患者选择、病变特征和并发症发生率等各种混杂因素，对这两种治疗方式进行可靠比较变得复杂。此外，大多数研究未描述最佳药物治疗的标准使用情况或缺血性疼痛缓解、伤口愈合或功能改善的结果。
腘下血管成形术和搭桥手术均能提供可接受的肢体挽救率，但搭桥手术后的通畅率似乎更佳。这两种治疗方式可能具有互补性。需要更多随机试验来为CLI和腘下动脉闭塞性疾病患者提供治疗方案。
