Rother Ulrich, Lang Werner, Horch Raymund E, Ludolph Ingo, Meyer Alexander, Regus Susanne
Department of Vascular Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany.
Department of Vascular Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Erlangen, Germany.
Ann Vasc Surg. 2017 Apr;40:190-197. doi: 10.1016/j.avsg.2016.07.084. Epub 2016 Nov 25.
Intact microperfusion of the foot in the critical ischemic limb remains a crucial condition for ulcer healing. Aim of this clinical study was to evaluate the immediate effect of tibial bypass surgery on the microcirculation by usage of fluorescence angiography.
Prospective analysis of 33 patients presenting with critical limb ischemia (Rutherford IV-VI) undergoing tibial bypass surgery was performed. Macroperfusion was investigated by measurement of ankle-brachial index. For assessment of microperfusion, intraoperative fluorescence angiography (SPY Elite, NOVADAQ) was undertaken during general anesthesia immediately before and after operation. For each investigation, a fluorescence dye (Indocyanine green) with an amount of 0.1 mg/kg was administered intravenously. Follow-up investigations were performed to assess the clinical outcome.
The mean follow-up time was 8.28 (±4.46) months. The parameters Ingress (IN) and Ingress rate (InR) of the fluorescence dye representing the microcirculation showed a significant improvement to preoperative values and correlated with the ankle-brachial index significantly. Furthermore, a significant difference between the individual improvement of the microcirculation parameters (preoperative-postoperative) between patients with postoperative clinical improvement (wound healing, absence of rest pain) and those without could be demonstrated (InR: P = 0.039, IN: P = 0.036).
The parameters IN and InR significantly reproduced the postoperative improvement of the microcirculation. An increased ankle-brachial index significantly correlated with increased microcirculation parameters. A better clinical outcome was found in those patients who had a higher relative improvement of microcirculation postoperatively.
严重缺血肢体足部的完整微灌注仍然是溃疡愈合的关键条件。本临床研究的目的是通过使用荧光血管造影术评估胫动脉搭桥手术对微循环的即时影响。
对33例接受胫动脉搭桥手术的严重肢体缺血（卢瑟福分级IV - VI级）患者进行前瞻性分析。通过测量踝肱指数来研究大灌注情况。为评估微灌注，在全身麻醉下于手术前后即刻进行术中荧光血管造影（SPY Elite，NOVADAQ）。每次检查时，静脉注射0.1mg/kg的荧光染料（吲哚菁绿）。进行随访调查以评估临床结果。
平均随访时间为8.28（±4.46）个月。代表微循环的荧光染料的进入量（IN）和进入速率（InR）参数较术前值有显著改善，且与踝肱指数显著相关。此外，术后临床改善（伤口愈合、无静息痛）的患者与未改善患者之间的微循环参数个体改善情况（术前 - 术后）存在显著差异（InR：P = 0.039，IN：P = 0.036）。
IN和InR参数显著反映了术后微循环的改善情况。踝肱指数升高与微循环参数增加显著相关。术后微循环相对改善较高的患者临床结果更好。
