Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria.
J Vasc Surg. 2014 Jun;59(6):1633-7. doi: 10.1016/j.jvs.2014.01.006. Epub 2014 Feb 19.
The objective of this study was to report on immediate and long-term outcomes after vein graft interposition in patients with upper- and lower-limb arterial injuries.
In the retrospective data analysis, all patients who underwent vein graft repair of limb arterial injuries in our civilian institution since 1990 were included, analyzed, and followed. Study end points were crude early and long-term patency, vascular reintervention, limb salvage, and perioperative death.
A total 152 consecutive patients (127 men; median age, 31.7 years; range, 5.3-77.2) who presented with 158 lesions of limb arteries (lower limb: n = 90; upper limb: n = 68) underwent repair with the use of vein graft interposition. The vast majority of lesions were caused by blunt trauma (n = 144; 91%). In early results, the 30-day mortality rate was 3.3%. In-hospital limb loss rate was significantly lower in the upper limb (n = 2; 2.9%) than in the lower limb (n = 12; 13.3%; P < .05). Primary early patency was 93% (upper limb) and 89% (lower limb): early graft occlusions occurred both in the upper limb (n = 5; 7%) and the lower limb (n = 10; 11%; P = .59). Occlusions were followed by amputation in six cases (upper limb: one of five; lower limb: five of 10) despite successful revision of the occluded grafts. Long-term results after a median follow-up period of 6.0 years (range, 0.3-23.4) showed upper limb (62% of patients were followed): no late limb loss, no vascular reintervention; patency: 97.6%; lower limb (66% of patients were followed): one late limb loss, one redo bypass for vein graft dilation, patency: 98.3%.
Emergency repair of civilian artery injuries with the use of vein grafts is associated with considerable risk of early occlusion and limb loss. When compared with the upper limb, limb loss rate is significantly higher in the lower extremity. Early graft occlusion is frequently followed by limb loss, especially in the lower limb. During long-term follow-up, occlusions of interposed vein grafts, vascular reinterventions, and late amputations are uncommon.
本研究旨在报告在上下肢动脉损伤患者中进行静脉移植物介入后的即时和长期结果。
在回顾性数据分析中，纳入了自 1990 年以来在我们的平民机构中接受肢体动脉损伤静脉修复的所有患者，并进行了分析和随访。研究终点为原始早期和长期通畅率、血管再介入、肢体存活率和围手术期死亡率。
共有 152 例连续患者（127 例男性；中位年龄 31.7 岁；范围 5.3-77.2 岁）因肢体动脉病变（下肢：90 例；上肢：68 例）接受了静脉移植物介入修复。绝大多数病变是由钝性创伤引起的（n = 144；91%）。早期结果显示，30 天死亡率为 3.3%。在住院期间，上肢（n = 2；2.9%）的肢体丧失率明显低于下肢（n = 12；13.3%；P <.05）。早期通畅率为 93%（上肢）和 89%（下肢）：早期移植物闭塞发生在上肢（n = 5；7%）和下肢（n = 10；11%；P =.59）。尽管闭塞的移植物成功修复，但在 6 例闭塞后发生了截肢（上肢：5 例中的 1 例；下肢：10 例中的 5 例）。在中位随访 6.0 年（范围 0.3-23.4）后的长期结果显示，上肢（62%的患者接受随访）：无晚期肢体丧失，无血管再介入；通畅率：97.6%；下肢（66%的患者接受随访）：晚期肢体丧失 1 例，静脉移植物扩张再旁路 1 例，通畅率：98.3%。
使用静脉移植物紧急修复平民动脉损伤与早期闭塞和肢体丧失的风险相当。与上肢相比，下肢的肢体丧失率明显更高。早期移植物闭塞常导致肢体丧失，尤其是下肢。在长期随访中，移植物内静脉移植物闭塞、血管再介入和晚期截肢并不常见。
