Naylor A R, Ah-See A K, Engeset J
Vascular Surgical Unit, Aberdeen Royal Infirmary, Forresterhill, UK.
Br J Surg. 1989 Jun;76(6):572-5. doi: 10.1002/bjs.1800760615.
Over a 10-year period, 241 patients with non-aneurysmal aortoiliac disease underwent aortofemoral bypass to 476 limbs. Four patients (1.7 per cent) occluded their grafts within 30 days of surgery, while 25 (10.4 per cent) suffered late graft occlusion. Postoperative occlusions were associated with significant morbidity and only one patient avoided major limb amputation or death. Overall, 46 episodes of graft thrombosis involving 51 graft limbs were encountered, the most common underlying cause being pre-existing or progressive multilevel distal occlusive disease. The overall cumulative graft patency rates were 95 and 87 per cent at 1 and 5 years respectively. Cumulative 5-year patency was significantly higher in patients presenting with claudication (91 per cent) than in patients presenting with rest pain (77 per cent) or ulceration and/or gangrene (71 per cent). Patients with evidence of multilevel distal occlusive disease at the time of aortic surgery had a significantly higher incidence of occlusion compared with those in whom there was no significant distal disease. In 35 episodes of occlusion (76 per cent), surgery was undertaken to restore limb blood flow, being successful in all but one case, with the most commonly performed procedure being graft limb thrombectomy. Seven of 28 patients (25 per cent) ultimately required major limb amputation and three patients died as a direct consequence of graft thrombosis.
在10年期间，241例非动脉瘤性主-髂动脉疾病患者接受了主-股动脉旁路移植术，共涉及476条肢体。4例患者（1.7%）在术后30天内发生移植血管闭塞，25例患者（10.4%）发生移植血管晚期闭塞。术后闭塞与显著的发病率相关，只有1例患者避免了大肢体截肢或死亡。总体而言，共发生46次移植血管血栓形成事件，累及51条移植血管肢体，最常见的潜在原因是既往存在或进行性的多节段远端闭塞性疾病。移植血管的总体累积通畅率在1年和5年时分别为95%和87%。出现间歇性跛行的患者5年累积通畅率（91%）显著高于出现静息痛的患者（77%）或溃疡和/或坏疽的患者（71%）。主动脉手术时存在多节段远端闭塞性疾病证据的患者闭塞发生率显著高于无明显远端疾病的患者。在35次闭塞事件（76%）中，进行了手术以恢复肢体血流，除1例病例外均获成功，最常进行的手术是移植血管肢体血栓切除术。28例患者中有7例（25%）最终需要进行大肢体截肢，3例患者因移植血管血栓形成直接死亡。
