Kretschmer G, Wenzl E, Piza F, Polterauer P, Ehringer H, Minar E, Schemper M
Surgery. 1987 Sep;102(3):453-9.
During the years 1970 to 1985, 463 patients with obliterative atherosclerosis at the femoropopliteal level underwent elective surgery. The operation performed was an autologous saphenous vein bypass using the reversed technique. The vascular surgical treatment was documented in reasonable detail (both baseline and follow-up) in accordance with the documentation system of the Austrian Society of Vascular Surgery. On-line data entry with use of SAS data-base management software was used. The patency curves were estimated in accordance with the Kaplan-Meier method; possible differences were checked by means Breslow's and Mantel's tests. The preoperative clinical status (claudicants, n = 200; limb salvage, n = 263) influenced the postoperative results in a statistically significant manner (Breslow p less than 0.01; Mantel p less than 0.03). All the other risk factors analyzed (site of distal anastomosis above versus below the knee, n = 231, and n = 232, respectively; Breslow p less than 0.58, Mantel p less than 0.58. Presence [n = 122] or nonpresence [n = 341], of diabetes mellitus [Breslow p less than 0.77, Mantel p less than 0.68]; smoking habits [nonsmokers, n = 93, smokers n = 370, Breslow p less than 0.68, Mantel p less than 0.69;]) did not reach statistical significance. Anticoagulant treatment (n = 101) had no effect (Breslow p less than 0.93, Mantel p less than 0.72), even when the therapy was restricted to cases with disease at advanced clinical stages (stages III, IV; n = 50; Breslow p less than 0.55, Mantel p less than 0.95). On the basis of these analyses, a prospective trial was initiated in 1979. Eighty-eight patients were studied; those in group I (n = 42) received dicumarol, and those in group II (n = 46) were controls who did not receive anticoagulant treatment. At present, the median follow-up time is at 30 months. Treatment with dicumarol favorably influenced graft patency (Breslow, p less than 0.03, Mantel p less than 0.07; one-tailed tests). The patients' preoperative clinical status affected the results of surgery (Breslow p less than 0.03, Mantel p less than 0.02; one-tailed tests). In relation to the preoperative clinical status, a therapeutic effect was observed in stages III and IV (n = 45; Breslow p less than 0.03, Mantel p less than 0.07; one-tailed tests), while no effect of therapy was demonstrable in claudicants (n = 43; Breslow p less than 0.3, Mantel p less than 0.4; one-tailed tests).(ABSTRACT TRUNCATED AT 400 WORDS)
1970年至1985年期间，463例股腘动脉闭塞性动脉粥样硬化患者接受了择期手术。所施行的手术是采用逆行技术的自体大隐静脉搭桥术。根据奥地利血管外科学会的记录系统，对血管外科治疗进行了较为详细的记录（包括基线和随访情况）。采用SAS数据库管理软件进行在线数据录入。通畅率曲线根据Kaplan-Meier方法估算；通过Breslow检验和Mantel检验检查可能存在的差异。术前临床状况（间歇性跛行患者，n = 200；肢体挽救患者，n = 263）对术后结果有统计学意义上的显著影响（Breslow p＜0.01；Mantel p＜0.03）。分析的所有其他危险因素（远端吻合口在膝上与膝下的部位，分别为n = 231和n = 232；Breslow p＜0.58，Mantel p＜0.58。糖尿病的存在与否[n = 122和n = 341]；Breslow p＜0.77，Mantel p＜0.68]；吸烟习惯[非吸烟者，n = 93，吸烟者n = 370，Breslow p＜0.68，Mantel p＜0.69]）均未达到统计学意义。抗凝治疗（n = 101）没有效果（Breslow p＜0.93，Mantel p＜0.72），即使将治疗限于临床晚期（III、IV期；n = 50）的病例也是如此（Breslow p＜0.55，Mantel p＜0.95）。基于这些分析，1979年启动了一项前瞻性试验。研究了88例患者；第一组（n = 42）接受双香豆素治疗，第二组（n = 46）为未接受抗凝治疗的对照组。目前，中位随访时间为30个月。双香豆素治疗对移植物通畅率有有利影响（Breslow，p＜0.03，Mantel p＜0.07；单侧检验）。患者的术前临床状况影响手术结果（Breslow p＜0.03，Mantel p＜0.02；单侧检验）。就术前临床状况而言，在III期和IV期（n = 45）观察到治疗效果（Breslow p＜0.03，Mantel p＜0.07；单侧检验），而在间歇性跛行患者（n = 43）中未显示出治疗效果（Breslow p＜0.3，Mantel p＜0.4；单侧检验）。（摘要截短至400字）
