Zeng Rong, Ye Wei, Li Yong-jun, Shao Jiang, Zheng Yue-hong, Liu Chang-wei
Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Wai Ke Za Zhi. 2013 Aug;51(8):719-22.
To summarize the outcome of revascularization for lower limbs thromboangiitis obliterans (TAO) and evaluate risk factors affected outcomes.
Between January 2008 and December 2011, a consecutive series of 24 TAO patients with lower limb ischemia were underwent revascularization. All the patients were male. The mean age was (33 ± 6) years (24-43 years). All patients presented with history of heavy smoking.Fifteen patients (62.5%) presented with ulcer or gangrene, 7 cases (29.2%) presented with rest pain, the rest 2 cases (8.3%) presented with severe intermittent claudication.Eight cases underwent bypass, including 6 autogenous vein graft, 1 prosthesis graft and 1 hybrid graft; 7 cases underwent catheter-directed thrombolysis combined with angioplasty; 3 cases underwent angioplasty and stenting directly; the rest 6 cases underwent thromboectomy and/or endarterectomy. The technical success, amputation and patency of target vessel were reported.Some risk factors were evaluated by multi-factors regression analysis to identify whether influenced outcomes.
Seventeen cases (70.8%) harvested primary technical success. Three cases (12.5%) suffered with major amputation due to failure of revascularization.Eight cases with bypass all were successful, 4 cases with thrombolysis got success, 2 cases with primary angioplasty and stenting got success, while the 3 cases with thromboemctomy and/or endarterectomy got success. Among the 7 failed cases, 3 cases needed major amputation, 2 cases underwent re-operation, and the rest 2 cases got conservation treatment. All the patients had effective follow-up between 1 and 40 months (mean (17 ± 11) months).No death occurred during the follow-up. Primary patency, secondary patency and limb salvage rate were 45.8% (11/24), 62.5% (15/24), and 79.2% (19/24), respectively.Risk factors regression analysis showed patients with ulcer or gangrene before revascularization got significant worse outcomes (Wald = 4.018, P = 0.043) . Bypass could improve outcomes significantly (Wald = 4.016, P = 0.045) .
Outcomes of revascularization for TAO with lower limb severe ischemia are acceptable. Autogenous vein graft bypass should be first choice. Thrombolysis with angioplasty could be a reasonable choice for those had no satisfied autogenous vein graft.
总结下肢血栓闭塞性脉管炎（TAO）血管重建的结果，并评估影响结果的危险因素。
2008年1月至2011年12月，连续24例下肢缺血的TAO患者接受了血管重建。所有患者均为男性。平均年龄为（33±6）岁（24 - 43岁）。所有患者均有大量吸烟史。15例（62.5%）出现溃疡或坏疽，7例（29.2%）出现静息痛，其余2例（8.3%）出现严重间歇性跛行。8例行旁路移植术，其中6例采用自体静脉移植，1例采用人工血管移植，1例采用杂交移植；7例行导管定向溶栓联合血管成形术；3例行直接血管成形术和支架置入术；其余6例行血栓切除术和/或动脉内膜切除术。报告了技术成功率、截肢情况及靶血管通畅情况。通过多因素回归分析评估一些危险因素，以确定是否影响结果。
17例（70.8%）获得了初步技术成功。3例（12.5%）因血管重建失败而接受了大截肢。8例旁路移植术均成功，4例溶栓成功，2例初次血管成形术和支架置入术成功，而3例血栓切除术和/或动脉内膜切除术成功。在7例失败病例中，3例需要大截肢，2例接受了再次手术，其余2例接受了保守治疗。所有患者均获得了1至40个月（平均（17±11）个月）的有效随访。随访期间无死亡发生。初次通畅率、二次通畅率和肢体挽救率分别为45.8%（11/24）、62.5%（15/24）和79.2%（19/24）。危险因素回归分析显示，血管重建术前有溃疡或坏疽的患者预后明显较差（Wald = 4.018，P = 0.043）。旁路移植术可显著改善预后（Wald = 4.016，P = 0.045）。
下肢严重缺血的TAO血管重建结果是可以接受的。自体静脉移植旁路术应作为首选。对于没有合适自体静脉移植的患者，溶栓联合血管成形术可能是一个合理的选择。
