Department of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Prüfeningerstraße 86, 93049 Regensburg, Germany.
Department of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Prüfeningerstraße 86, 93049 Regensburg, Germany.
Int J Surg. 2015 Jan;13:261-266. doi: 10.1016/j.ijsu.2014.12.010. Epub 2014 Dec 18.
Endovascular recanalization has become the accepted first-line treatment strategy for most lower extremity arterial occlusions, especially in patients with critical limb ischemia (Rutherford 4-6). Prior endovascular interventions have been described as risk factors for the outcome of subsequent lower extremity bypass surgery. The effect on subsequent tibial and peroneal bypasses is controversial. We analyzed the impact of prior endovascular lower extremity revascularization procedures on the short- and mid-term results of femoro-tibial and femoro-peroneal bypasses.
A retrospective analysis was conducted of all patients who had undergone tibial or peroneal bypass surgery after prior endovascular interventions (PEI-Group, n=40) of the same extremity in our department from October 2007 to October 2012. We compared this group with a group of patients who had received a tibial or peroneal bypass as primary revascularization procedure (BF-Group, n=93) during the same period of time because primary endovascular therapy had been deemed unfeasible in those cases. Indication in all cases was critical limb ischemia; the median age was 78 years (range 50-90 years), 45.1% were diabetics, and 42.9% were female. The graft material was autologous vein in 80 cases and HePTFE in 53 cases. Endpoints of the analysis were primary and secondary patency rates, limb salvage and survival at 2 years postoperatively.
At 2 years overall primary patency was 68.4%, secondary patency was 69.5%, limb salvage was 83.6% and survival was 62.6%. Primary patency for the BF-Group was 74.3% vs. 55.1% for the PEI-Group (P=.310) at 2 years; secondary patency was 74.6% vs. 59.1% (P=.268). Prior endovascular intervention did not have any significant effects on limb salvage (83.7% vs. 83.6%; P=.470) or survival rates (61.0% vs. 65.0%; P=.258) at the 2-year mark, either. There were no significant differences in graft occlusion, death and major amputation rates within the first 30 postoperative days. Except for male gender, there were no significant differences in risk factors and indications between the two groups.
Prior endovascular intervention of femoro-tibial vessels does not have a negative impact on the outcome of subsequent tibial or peroneal bypass surgery in patients with critical limb ischemia.
腔内血管再通术已成为大多数下肢动脉闭塞症的首选一线治疗策略，尤其是在伴有严重肢体缺血（Rutherford 4-6 级）的患者中。先前的腔内血管介入治疗被认为是影响后续下肢旁路手术结果的危险因素。其对后续胫腓骨和腓骨旁路的影响存在争议。我们分析了先前下肢血管腔内再通术对股胫和股腓旁路术短期和中期结果的影响。
对 2007 年 10 月至 2012 年 10 月期间我科因同一肢体先前腔内干预（PEI 组，n=40）而接受胫腓骨或腓骨旁路手术的所有患者进行回顾性分析。我们将该组与同一时期因主要腔内治疗不可行而接受胫腓骨或腓骨旁路作为主要血运重建术的患者组（BF 组，n=93）进行比较。所有病例的适应证均为严重肢体缺血；中位年龄为 78 岁（范围 50-90 岁），45.1%为糖尿病患者，42.9%为女性。移植物材料为自体静脉 80 例，HePTFE 53 例。分析的终点为术后 2 年的一期和二期通畅率、肢体存活率和生存情况。
总体而言，术后 2 年一期通畅率为 68.4%，二期通畅率为 69.5%，肢体存活率为 83.6%，生存率为 62.6%。BF 组术后 2 年的一期通畅率为 74.3%，PEI 组为 55.1%（P=.310）；二期通畅率为 74.6%vs.59.1%（P=.268）。术前腔内干预对术后 2 年的肢体存活率（83.7%vs.83.6%；P=.470）和生存率（61.0%vs.65.0%；P=.258）均无显著影响。术后 30 天内，两组在移植物闭塞、死亡和主要截肢率方面无显著差异。除性别外，两组在危险因素和适应证方面无显著差异。
在严重肢体缺血患者中，先前的股胫血管腔内干预不会对后续胫腓骨或腓骨旁路手术的结果产生负面影响。
