Naylor A R, Ah-See A K, Engeset J
Vascular Surgery Unit, Aberdeen Royal Infirmary, UK.
Br J Surg. 1990 Jun;77(6):659-61. doi: 10.1002/bjs.1800770623.
Thirty-eight patients presenting with severe limb ischaemia and considered unfit for major aortic reconstruction underwent axillofemoral bypass as a limb salvage procedure. Four patients (11 per cent) died, including two who had presented with bilateral ischaemia secondary to acute aortic occlusion. The operative mortality rate for patients presenting with rest pain or ulceration/gangrene was 6 per cent. Cumulative 5-year survival and limb salvage were 44 per cent and 86 per cent respectively. Graft occlusion was the principal cause of worsening symptoms during follow-up (5-year primary patency of 68 per cent) and accounted for all major amputations of the operated limb. Axillounifemoral grafts had a significantly worse 5-year patency (50 per cent) than axillobifemoral grafts (80 per cent, P less than 0.05) and three of five patients who developed worsening symptoms in the non-operated limb died or required a major limb amputation as a consequence. Axillofemoral bypass is a valuable alternative to major aortic reconstruction in elderly patients and allows a greater proportion to be offered reconstruction than would otherwise be possible.
38例患有严重肢体缺血且被认为不适合进行主动脉大手术重建的患者接受了腋股旁路移植术作为肢体挽救手术。4例患者（11%）死亡，其中2例因急性主动脉闭塞继发双侧缺血。出现静息痛或溃疡/坏疽的患者手术死亡率为6%。5年累积生存率和肢体挽救率分别为44%和86%。移植血管闭塞是随访期间症状恶化的主要原因（5年原发性通畅率为68%），并且是所有接受手术肢体进行大截肢的原因。腋单股移植血管的5年通畅率（50%）明显低于腋双股移植血管（80%，P<0.05），并且在未手术肢体出现症状恶化的5例患者中有3例因此死亡或需要进行大肢体截肢。腋股旁路移植术是老年患者主动脉大手术重建的一种有价值的替代方法，与其他情况相比，能使更多患者有机会接受重建手术。
