Dalsing M C, Hoagland W P, Becker G, Holden R W, Cockerill E, Glover J L
Indiana Med. 1989 Sep;82(9):700-5.
Is percutaneous iliac angioplasty before distal bypass a logical limb salvage option in a high-risk patient? A retrospective review of 113 iliac angioplasty procedures identified 10 patients in this situation. Angioplasty preceded femoropopliteal bypass (five), femorotibial bypass (three) and, in one case each, femorofemoral bypass or profundoplasty. There were no interventional deaths or complications. Ankle/brachial pressure index improvement followed intervention: 0.28 + 0.2 vs. 0.92 + 0.08, (p less than 0.0005). Limb salvage was 90% at one month, 80% at six months and 70% at one to three years by Life-Table analysis. Two patients with a patent bypass lost limbs from uncontrolled infection within two months. One patient required an amputation 311 days after the only failure of angioplasty and distal bypass. During this study period, 56% of the patients died. This review supports an angioplasty/bypass combined intervention as a valuable treatment option in high-risk patients facing limb loss.
对于高危患者，在进行远端旁路手术前先行经皮髂血管成形术是否是一种合理的保肢选择？对113例髂血管成形术进行回顾性分析，确定有10例患者属于这种情况。血管成形术先于股腘旁路手术（5例）、股胫旁路手术（3例），各有1例先于股股旁路手术或股深动脉成形术。无介入相关死亡或并发症。干预后踝/臂压力指数改善：术前为0.28±0.2，术后为0.92±0.08，（p＜0.0005）。通过寿命表分析，1个月时保肢率为90%，6个月时为80%，1至3年时为70%。2例旁路通畅的患者在两个月内因感染失控而截肢。1例患者在血管成形术和远端旁路手术唯一一次失败311天后需要截肢。在本研究期间，56%的患者死亡。本综述支持血管成形术/旁路联合干预作为面临肢体丧失的高危患者的一种有价值的治疗选择。
