Pshenichnyĭ V N, Shtutin A A, Ivanenko A A, Voropaev V V, Koval'chuk O N, Gaevoĭ V L
Angiol Sosud Khir. 2012;18(3):132-7.
to determine the scope of infrainguinal revascularization of the limb in patients with multilevel lesions of arteries in chronic critical lower limb ischaemia (CCLLI).
A retrospective analysis of graft patency and limb salvage included a total of 76 patients undergoing a total of 78 bypass procedures consisting of: 1) two-level infrainguinal reconstructions (n = 35), 2) femoral-tibial (n = 36) and femoralplantar (n 7) bypass procedures. All patients had an isolated segment, of the popliteal artery in a combination with bifurcation arterial occlusive disease. Autovenous reversed retrograde and orthotopic in (situ vein grafts were used. All patients underwent intraoperative haemodynamic measurements. Graft patency was assessed by Doppler monitoring. The two groups studied were compared by demographic features and risk factors by means of the Student's and chi-squared tests.
Life-table analysis showed demonstrated that two-level infrainguinal reconstructions provided better primary 3-year patency (76.2%) as compared with femoral-tibia! and plantar bypasses (60.4%, p<0.05). Intraoperative mortality occurred in 2 patients (2.5%). Early and mid-term thromboses appeared to be most frequently encountered in the group of femoral-tibial, and plantar reconstructions (18.6% vs 11.4%, p<0.38 and 30.8% vs 10.3%, p=0.04, respectively).
Two-level infrainguinal arterial reconstruction in patients with CCLLI is an acceptable procedure alternative providing better graft patency higher limb salvage rate as compared with femoral-tibial or femoroplantar bypass.
确定慢性严重下肢缺血（CCLLI）患者下肢膝下血管重建的范围。
对移植物通畅情况和肢体挽救情况进行回顾性分析，共纳入76例患者，进行了78例旁路手术，包括：1）两级膝下重建（n = 35），2）股-胫（n = 36）和股-跖（n = 7）旁路手术。所有患者均有腘动脉孤立节段合并分叉处动脉闭塞性疾病。使用了自体静脉逆行和顺行原位静脉移植物。所有患者均接受术中血流动力学测量。通过多普勒监测评估移植物通畅情况。采用学生t检验和卡方检验对研究的两组患者的人口统计学特征和危险因素进行比较。
寿命表分析显示，两级膝下重建的3年原发性通畅率（76.2%）优于股-胫和跖旁路手术（60.4%，p<0.05）。2例患者（2.5%）发生术中死亡。早期和中期血栓形成似乎在股-胫和跖重建组中最常见（分别为18.6%对11.4%，p<0.38；30.8%对10.3%，p = 0.04）。
与股-胫或股-跖旁路手术相比，CCLLI患者的两级膝下动脉重建是一种可接受的手术选择，具有更好的移植物通畅率和更高的肢体挽救率。
