Hahn Hyung Min, Jeong Yeon Seong, Hong You Sun, Won Je Hwan, Lim Sang Hyun, Kim Jinoo, Park Myong Chul, Park Dong Ha, Lee Il Jae
Ajou University School of Medicine, Suwon, Republic of Korea.
Ajou University School of Medicine, Suwon, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2017 May;70(5):606-617. doi: 10.1016/j.bjps.2017.01.010. Epub 2017 Feb 16.
This study aimed to demonstrate the safety and reliability of combined preoperative angioplasty and free flap transfer in patients with peripheral arterial occlusive disease (PAOD) by analyzing the surgical outcomes.
Between October 2011 and October 2015, patients who had undergone lower extremity angiography and subsequent free flap transfer were retrospectively reviewed. Data collected included demographics, perioperative data, and postoperative outcomes. The cases were divided into two groups: one group with microanastomosis performed on revascularized artery by balloon angioplasty and the other group performed on native artery. Multiple logistic regression model using propensity score and linear regression was computed to determine the association between preoperative angioplasty and the surgical outcomes.
A total of 62 lower limb reconstruction cases (19 angioplastied cases and 43 nonangioplastied cases) were included in the study. Complications occurred in 6 cases in the angioplastied group and in 11 cases in the control group. The overall limb salvage rate was 100% during the average follow-up of 29.5 months in the angioplastied group and 97.7% in the nonangioplastied control group during the average follow-up of 31.1 months. Preoperative angioplasty was not a significant predictor of increased complications and longer postoperative downtime in logistic and linear regression model, both in the weighted and unweighted model.
The combined approach of preoperative endovascular revascularization and free flap transfer for limb reconstruction in PAOD patients can be performed safely and effectively with acceptable morbidity.
本研究旨在通过分析手术结果，论证术前血管成形术联合游离皮瓣移植治疗外周动脉闭塞性疾病（PAOD）患者的安全性和可靠性。
回顾性分析2011年10月至2015年10月期间接受下肢血管造影及后续游离皮瓣移植的患者。收集的数据包括人口统计学资料、围手术期数据和术后结果。病例分为两组：一组在经球囊血管成形术再血管化的动脉上进行显微吻合，另一组在原生动脉上进行显微吻合。采用倾向评分的多因素logistic回归模型和线性回归分析，以确定术前血管成形术与手术结果之间的关联。
本研究共纳入62例下肢重建病例（血管成形术组19例，非血管成形术组43例）。血管成形术组6例发生并发症，对照组11例发生并发症。血管成形术组平均随访29.5个月，总体肢体挽救率为100%；非血管成形术对照组平均随访31.1个月，总体肢体挽救率为97.7%。在logistic回归模型和线性回归模型中，无论是加权模型还是非加权模型，术前血管成形术均不是并发症增加和术后停机时间延长的显著预测因素。
对于PAOD患者，术前血管内再血管化联合游离皮瓣移植进行肢体重建的联合方法可以安全有效地实施，且发病率可接受。
