Arhuidese Isibor, Malas Mahmoud, Obeid Tammam, Massada Karen, Khaled Alaa, Alzahrani Anas, Samaha Georges, Reifsnyder Thomas
Division of Vascular Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Md.
Division of Vascular Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Md.
J Vasc Surg. 2016 Jul;64(1):117-23. doi: 10.1016/j.jvs.2015.12.057. Epub 2016 Mar 19.
There are limited reports of outcomes after infrainguinal bypass surgery in patients with scleroderma. This study evaluated the long-term outcome after lower extremity bypass in these patients.
The study included all patients with systemic sclerosis who underwent infrainguinal bypass surgery for severe peripheral arterial disease at our institution from January 1, 2007, to August 31, 2014. Kaplan-Meier and Cox regression analyses were used to evaluate graft failure and limb salvage. These outcomes were compared with those of nonscleroderma patients who underwent infrainguinal bypass surgery during the same period. Outcomes were defined and evaluated by Society for Vascular Surgery standards.
There were 18 autogenous grafts (6% femoral-popliteal, 11% femoral-tibial, 72% popliteal-tibial, 11% tibial-tibial) placed in 18 limbs from 12 patients with systemic sclerosis. Mean ± standard deviation age was 71 ± 9.5 years, and most of the patients were women (83%) and white (78%). All patients presented with critical limb ischemia. History of hypertension and coronary artery disease were 94% and 61%, respectively. All grafts used were autogenous, continuous, and harvested from the lower extremity (nonreversed great saphenous in 61% and reversed great saphenous in 39%). Mean follow-up duration was 2.3 ± 1.6 years. Graft failure was significantly higher in scleroderma patients than in nonscleroderma patients who underwent bypass in the same study period (hazard ratio, 7.2; 95% confidence interval, 1.44-41.4; P = .02). The limb salvage rate was 72%.
Long-term outcomes after open infrainguinal bypass surgery in scleroderma patients are significantly worse than those in nonscleroderma patients. Careful consideration of their inherently poor outcomes should be made when reaching a decision for revascularization.
关于硬皮病患者行股动脉以下旁路手术的预后报道有限。本研究评估了这些患者下肢旁路手术后的长期预后。
本研究纳入了2007年1月1日至2014年8月31日期间在我院因严重外周动脉疾病接受股动脉以下旁路手术的所有系统性硬化症患者。采用Kaplan-Meier法和Cox回归分析评估移植物失败和肢体挽救情况。将这些结果与同期接受股动脉以下旁路手术的非硬皮病患者的结果进行比较。结果按照血管外科学会的标准进行定义和评估。
12例系统性硬化症患者的18条肢体植入了18条自体移植物（6%为股-腘动脉，11%为股-胫动脉，72%为腘-胫动脉，11%为胫-胫动脉）。平均年龄±标准差为71±9.5岁，大多数患者为女性（83%）且为白人（78%）。所有患者均表现为严重肢体缺血。高血压和冠状动脉疾病史分别为94%和61%。所有使用的移植物均为自体、连续的，且取自下肢（61%为非翻转大隐静脉，39%为翻转大隐静脉）。平均随访时间为2.3±1.6年。硬皮病患者的移植物失败率显著高于同期接受旁路手术的非硬皮病患者（风险比，7.2；95%置信区间，1.44 - 41.4；P = .02）。肢体挽救率为72%。
硬皮病患者开放性股动脉以下旁路手术后的长期预后明显差于非硬皮病患者。在决定进行血管重建时，应仔细考虑其固有的不良预后。
