Mifsud Maximilian, Cassar Kevin
Department of Surgery, Mater Dei Hospital, Msida, Malta, EU.
Department of Surgery, Mater Dei Hospital, Msida, Malta, EU.
Ann Vasc Surg. 2015 Nov;29(8):1524-32. doi: 10.1016/j.avsg.2015.05.040. Epub 2015 Aug 28.
Infrainguinal bypass surgery is frequently associated with postoperative reperfusion edema of the limb. The etiology is thought to be multifactorial, and there is as yet no standardized treatment protocol for this problem. The primary aim of this study was to assess whether the use of intermittent electrical stimulation of the calf muscles after infrainguinal bypass surgery was effective in reducing the incidence of edema, and the secondary aims to determine the effect of calf muscle stimulation on arterial and venous flow in the operated leg.
Forty patients due to undergo infrainguinal bypass surgery for critical lower-limb ischemia (Fontaine grading III-IV or Rutherford grading II-III) were recruited prospectively and randomly divided into the control group, who received the current standard of care, and study group, who received electrical calf muscle stimulation for a 1 hour session twice daily for the first postoperative week. Preoperatively and postoperatively, the leg was measured at 3 predetermined points and a duplex ultrasound scan performed.
The groups were well matched for all parameters. At 1 week, the below knee and calf girth were less in the study group (P = 0.025 and P = 0.043, respectively). Venous flow volumes at rest and on stimulation were higher in the study group (P = 0.010 and P = 0.029, respectively). At 6 weeks, the below knee girth and amount of pitting edema were less in the study group (P = 0.011 and P = 0.014, respectively).
We conclude that transcutaneous electrical stimulation of the calf decreased lower-limb swelling at 1 and 6 weeks, and increased the venous flow volume at rest and on stimulation at 1 week in patients undergoing infrainguinal bypass surgery for critical ischemia regardless of patient factors or the type of bypass surgery performed or graft used.
股下旁路手术常伴有术后肢体再灌注水肿。其病因被认为是多因素的，并且对于这个问题尚无标准化的治疗方案。本研究的主要目的是评估股下旁路手术后使用小腿肌肉间歇性电刺激是否能有效降低水肿发生率，次要目的是确定小腿肌肉刺激对手术侧下肢动静脉血流的影响。
前瞻性招募了40例因严重下肢缺血（Fontaine分级III - IV级或Rutherford分级II - III级）需行股下旁路手术的患者，并将其随机分为对照组（接受当前的标准治疗）和研究组（术后第一周每天接受两次1小时的小腿肌肉电刺激）。术前和术后，在3个预定点测量下肢，并进行双功超声扫描。
两组在所有参数上匹配良好。在术后1周时，研究组的膝下和小腿周长较小（分别为P = 0.025和P = 0.043）。研究组静息和刺激时的静脉血流量较高（分别为P = 0.010和P = 0.029）。在术后6周时，研究组的膝下周长和凹陷性水肿量较少（分别为P = 0.011和P = 0.014）。
我们得出结论，对于因严重缺血而行股下旁路手术的患者，无论患者因素、所进行的旁路手术类型或使用的移植物如何，经皮电刺激小腿在术后1周和6周时可减轻下肢肿胀，并在术后1周时增加静息和刺激时的静脉血流量。
