Wei Zhiqing, Yang Qipeng, Gong Jieming, Liu Changjian
Department of Vascular and Endovascular Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210000, P.R.China.
Department of Vascular and Endovascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Nov;27(11):1359-62.
To evaluate the immediate and mid-term effectiveness of hybrid procedures (combined open surgery and endovascular therapy) for multilerel femoral and popliteal artery occlusive disease.
Between June 2009 and June 2012, 22 cases of severe femoral and popliteal artery occlusive disease were treated by hybrid surgery. There were 15 men and 7 women with an age range of 52-78 years (mean, 66.2 years) and with a disease duration of 6 months to 5 years (mean, 1.5 years). Of 22 patients, 13 had a history of smoking; 8 were classified as Fontaine III and 14 as Fontaine IV. The complications included diabetes (8 patients), hypertension (16 patients), hyperlipemia (10 patients), coronary heart disease (11 patients), and chronic kidney failure (1 patient). Patency analyses were performed using Kaplan-Meier life tables and log-rank test.
All patients underwent successfully procedures. The time of operation was 70-160 minutes (mean, 137 minutes). Acute myocardial infarction, hematoma of incision, fracture of stent, and stent thrombosis occurred in 1 case, respectively. At 6 months after surgery, the ankle brachial index (ABI), the transcutaneous oxygen pressure (TcpO2), and the average intermittent claudication distance were significantly increased when compared with preoperative ones [0.79 +/- 0.33 versus 0.32 +/- 0.18, (42.7 +/- 15.7) kPa versus (17.6 +/- 11.6) kPa, and (420 +/- 80) m versus (160 +/- 54) m, P < 0.05]. The patients were followed up 6-24 months (mean, 14.5 months). The primary patency rate, primary assisted patency rate, and second patency rate were 77.3% (17/22), 90.9% (20/22), and 95.5% (21/22) respectively, showing no significant difference among them (P > 0.05). No significant difference was found in various-stage patency rates between patients at Fontaine III and IV (P > 0.05).
Hybrid procedures provide an effective treatment of multilevel femoral artery and popliteal artery disease while there is good outflow.
评估杂交手术（开放手术与血管内治疗相结合）治疗多节段股动脉和腘动脉闭塞性疾病的近期和中期疗效。
2009年6月至2012年6月，22例严重股动脉和腘动脉闭塞性疾病患者接受了杂交手术治疗。其中男性15例，女性7例，年龄52 - 78岁（平均66.2岁），病程6个月至5年（平均1.5年）。22例患者中，13例有吸烟史；8例为Fontaine III级，14例为Fontaine IV级。并发症包括糖尿病（8例）、高血压（16例）、高脂血症（10例）、冠心病（11例）和慢性肾衰竭（1例）。采用Kaplan-Meier生存表和对数秩检验进行通畅性分析。
所有患者手术均成功。手术时间为70 - 160分钟（平均137分钟）。急性心肌梗死、切口血肿、支架断裂和支架血栓形成各发生1例。术后6个月时，与术前相比，踝肱指数（ABI）、经皮氧分压（TcpO2）和平均间歇性跛行距离显著增加[0.79±0.33对0.32±0.18，（42.7±15.7）kPa对（17.6±11.6）kPa，以及（420±80）m对（160±54）m，P<0.05]。患者随访6 - 24个月（平均14.5个月）。一期通畅率、一期辅助通畅率和二期通畅率分别为77.3%（17/22）、90.9%（20/22）和95.5%（21/22），三者之间差异无统计学意义（P>0.05）。Fontaine III级和IV级患者各阶段通畅率差异无统计学意义（P>0.05）。
杂交手术在流出道良好的情况下，为多节段股动脉和腘动脉疾病提供了一种有效的治疗方法。
