Spinelli Francesco, Pipitò Narayana, Martelli Eugenio, Benedetto Filippo, De Caridi Giovanni, Spinelli Domenico, Stilo Francesco
Division of Vascular Surgery, University of Campus Bio-Medico, Rome, Italy.
Division of Vascular Surgery, Department of Cardiovascular and Thoracic Sciences, University of Messina, Messina, Italy.
Ann Vasc Surg. 2015 Feb;29(2):272-7. doi: 10.1016/j.avsg.2014.09.032. Epub 2014 Nov 26.
The aims of this study were to determine the effect of failed prior endovascular treatment (EV) on early and midterm outcomes of subsequent lower extremity open surgical (OS) bypass.
Patients undergoing infrainguinal bypass for critical limb ischemia (CLI) from January 2008 to December 2011 were retrospectively reviewed. The results after first-line bypass and bypass after failure of EV treatment were compared. A total of 213 patients (65.25% men; average age, 73.30 years) underwent bypass. OS patients were then divided into 2 groups: group 1 consisted of 138 patients who underwent primary OS for CLI without prior EV (control group) and group 2 consisted of 75 patients who had OS after a failed attempt at elective EV for peripheral vascular disease. Of the 213 bypass performed, 34% had a prior infrainguinal failed EV. The primary study end points were early and 1-year major amputations and graft occlusion. The secondary outcomes included early and 1-year mortality and the level of distal revascularization.
Secondary patency and limb salvage rates were significantly better in group 1 up to 1 year (99% vs. 86%; P < 0.001 at 1 month and 95% vs. 76%, P < 0.05 at 12 months, respectively).
Previous failed EV should be predictive of poor outcome in patients undergoing distal OS for CLI.
本研究旨在确定先前血管内治疗（EV）失败对随后下肢开放手术（OS）旁路移植术早期和中期结果的影响。
回顾性分析2008年1月至2011年12月因严重肢体缺血（CLI）接受腹股沟下旁路移植术的患者。比较一线旁路移植术的结果与EV治疗失败后的旁路移植术结果。共有213例患者（65.25%为男性；平均年龄73.30岁）接受了旁路移植术。然后将OS患者分为两组：第1组由138例未经先前EV治疗而因CLI接受原发性OS的患者组成（对照组），第2组由75例因外周血管疾病选择性EV治疗失败后接受OS的患者组成。在进行的213例旁路移植术中，34%有先前腹股沟下EV治疗失败的情况。主要研究终点为早期和1年的大截肢和移植物闭塞。次要结果包括早期和1年死亡率以及远端血管重建水平。
第1组在1年内的二次通畅率和肢体挽救率明显更好（分别为99%对86%；1个月时P<0.001，12个月时95%对76%，P<0.05）。
先前EV治疗失败应可预测因CLI接受远端OS的患者预后不良。
