Marqués de Marino P, Martínez López I, Revuelta Suero S, Hernández Mateo M M, Cernuda Artero I, Cabrero Fernández M, Serrano Hernando F J
Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, C/ Martín Lagos s/n, 28040 Madrid, Spain.
Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, C/ Martín Lagos s/n, 28040 Madrid, Spain.
Eur J Vasc Endovasc Surg. 2016 Jun;51(6):824-30. doi: 10.1016/j.ejvs.2016.03.023. Epub 2016 Apr 25.
OBJECTIVE/BACKGROUND: To assess the outcomes of infrainguinal bypass performed for acute limb ischaemia, as well as the predictors of patency, mortality, and amputation.
This was a retrospective cohort study of patients undergoing infrainguinal bypass between 1998 and 2014. The cohort was stratified according to the indication for surgery into two groups: group A (acute limb ischaemia) and group B (chronic lower extremity ischaemia). Comparative analysis was performed on comorbidities, surgical technique, and outcomes, as well as prognostic factors in group A.
In total, 702 bypasses were performed (group A, n = 107; group B, n = 595). Differences between groups were detected in age (65.9 vs. 70.9 years; p = .03), diabetes (16% vs. 49%; p < .01), renal insufficiency (6% vs. 13%; p = .05), stroke (7% vs. 14%; p = .04), and coronary artery disease (13% vs. 28%; p < .01). Patients with acute limb ischaemia more often required general anaesthesia (47% vs. 12%; p < .01) and a short bypass was more often performed (32% vs. 7%; p < .01). Median follow up was 23 and 24 months for groups A and B, respectively. No differences were found in patency rates at 1, 12, and 24 months between groups, but group B had a higher re-intervention rate during follow up. Primary patency in group A was 84%, 63%, and 58%, and in group B it was 88%, 62%, and 53% at 1, 12, and 24 months, respectively (p = .77). Assisted primary patency in group A was 85%, 72%, and 67%, and in group B it was 90%, 74%, and 66% at 1, 12, and 24 months, respectively (p = .61). Secondary patency in group A was 90%, 78%, and 75%, and in group B it was 94%, 80%, and 74% at 1, 12, and 24 months, respectively (p = .80). The freedom from re-intervention rate in group A was 91%, 74%, and 68%, and in group B it was 92%, 76%, and 71%, respectively (p = .04). Acute limb ischaemia was an independent risk factor for amputation (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.74-14.09; p < .01) and mortality (OR 4.13, 95% CI 1.53-11.14; p = .01) at 30 days. In group A, female sex, prosthetic conduit, and need of distal thrombectomy were independently associated with worse patency rates. Poor intra-operative runoff was correlated with higher amputation rates.
Among those undergoing infrainguinal bypass, patients who present with acute limb ischaemia constitute a subset showing higher early rates of amputation and death. In this subset of patients, worse outcomes may be expected for women, prosthetic conduits, need for distal thrombectomy, and patients with poor intra-operative runoff.
目的/背景：评估为急性肢体缺血进行的股下旁路手术的结果，以及通畅率、死亡率和截肢的预测因素。
这是一项对1998年至2014年间接受股下旁路手术患者的回顾性队列研究。该队列根据手术指征分为两组：A组（急性肢体缺血）和B组（慢性下肢缺血）。对合并症、手术技术、结果以及A组的预后因素进行了比较分析。
共进行了702例旁路手术（A组，n = 107；B组，n = 595）。两组在年龄（65.9岁对70.9岁；p = .03）、糖尿病（16%对49%；p < .01）、肾功能不全（6%对13%；p = .05）、中风（7%对14%；p = .04）和冠状动脉疾病（13%对28%；p < .01）方面存在差异。急性肢体缺血患者更常需要全身麻醉（47%对12%；p < .01），且更常进行短旁路手术（32%对7%；p < .01）。A组和B组的中位随访时间分别为23个月和24个月。两组在1个月、12个月和24个月时的通畅率无差异，但B组在随访期间的再次干预率更高。A组在1个月、12个月和24个月时的原发性通畅率分别为84%、63%和58%，B组分别为88%、62%和53%（p = .77）。A组在1个月、12个月和24个月时的辅助原发性通畅率分别为85%、72%和67%，B组分别为90%、74%和66%（p = .61）。A组在1个月、12个月和24个月时的继发性通畅率分别为9%、78%和75%，B组分别为94%、80%和74%（p = .80）。A组的无再次干预率分别为91%、74%和68%，B组分别为92%、76%和71%（p = .04）。急性肢体缺血是30天时截肢（比值比[OR] 4.96，95%置信区间[CI] 1.74 - 14.09；p < .01）和死亡（OR 4.13，95% CI 1.53 - 11.14；p = .01）的独立危险因素。在A组中，女性、人工血管以及需要进行远端血栓切除术与较差的通畅率独立相关。术中血流不佳与较高的截肢率相关。
在接受股下旁路手术患者中，出现急性肢体缺血的患者构成了一个截肢和死亡早期发生率较高的亚组。在这个亚组患者中，女性、人工血管、需要进行远端血栓切除术以及术中血流不佳的患者可能预后较差。
