Uhl C, Grosch C, Hock C, Töpel I, Steinbauer M
Department of Vascular Surgery, Barmherzige Brüder Regensburg, Regensburg, Germany.
Department of Vascular Surgery, Barmherzige Brüder Regensburg, Regensburg, Germany.
Eur J Vasc Endovasc Surg. 2017 Aug;54(2):203-211. doi: 10.1016/j.ejvs.2017.05.001. Epub 2017 Jun 3.
OBJECTIVE/BACKGROUND: Endovascular first is the preferred therapy approach to critical limb ischaemia (CLI). However, in spite of new endovascular techniques, bypass surgery still plays an important role, especially in patients with complex anatomy in whom endovascular therapy is not considered feasible, or has failed. The goal of this study was to analyse the outcomes of prosthetic or autologous vein for femoropopliteal (P3) bypasses performed under the abovementioned conditions.
A retrospective analysis of patients who underwent a femoropopliteal (P3) bypass for CLI (March 2007-December 2015) was conducted. Endovascular therapy was not possible. Patency rates, limb salvage, major adverse limb event (MALE) free survival, and survival after 5 years were analysed.
In total, 151 cases were included in the analysis (rest pain 35.8%, ulcer/gangrene 64.3%). The graft material was autologous vein in 76 cases (vein group) and heparin bonded expanded polytetrafluoroethylene (HePTFE) in 75 cases (HePTFE group). Indications, risk factors, previous revascularisation procedures, and runoff vessels were similar in both groups. Thirty day mortality was 6.6% in the vein group and 5.3% in the HePTFE group (p = .508), early graft occlusion (6.6% vs. 5.3%; p = .508) and 30 day major amputation rate (0% vs. 2.7%; p = .245) were similar between the two groups. Overall primary patency was 51.7% (55.5% [vein group] vs. 51.7% [HePTFE group]; p = .897) and overall secondary patency was 64.2% (74.6% [vein group] vs. 55.6% [HePTFE group]; p = .119), all without significance after 5 years. However, limb salvage (79.1%) was significantly different (90.0% [vein group] vs. 62.9% [HePTFE group]; p = .021). Survival was similar between the groups (47.3% vs. 42.9%; p = .582) as well as MALE free survival (69.4% vs. 55.0%; p = .348).
Bypasses to the below knee popliteal artery show good results in patients with CLI unsuitable for endovascular therapy. Vein is still the first line graft material.
目的/背景：血管腔内治疗优先是治疗严重肢体缺血（CLI）的首选方法。然而，尽管有新的血管腔内技术，旁路手术仍然发挥着重要作用，特别是在解剖结构复杂、血管腔内治疗不可行或失败的患者中。本研究的目的是分析在上述情况下进行股腘（P3）旁路移植术使用人工血管或自体静脉的结果。
对2007年3月至2015年12月因CLI接受股腘（P3）旁路移植术的患者进行回顾性分析。无法进行血管腔内治疗。分析通畅率、肢体挽救率、无重大肢体不良事件（MALE）生存率和5年后生存率。
总共151例纳入分析（静息痛35.8%，溃疡/坏疽64.3%）。移植材料为自体静脉76例（静脉组），肝素结合膨体聚四氟乙烯（HePTFE）75例（HePTFE组）。两组的适应症、危险因素、既往血运重建手术和流出道血管相似。静脉组30天死亡率为6.6%，HePTFE组为5.3%（p = 0.508），早期移植物闭塞（6.6%对5.3%；p = 0.508）和30天主要截肢率（0%对2.7%；p = 0.245）两组相似。总体原发性通畅率为51.7%（静脉组为55.5%对HePTFE组为51.7%；p = 0.897），总体继发性通畅率为64.2%（静脉组为74.6%对HePTFE组为55.6%；p = 0.119），5年后均无显著差异。然而，肢体挽救率（79.1%）有显著差异（静脉组为90.0%对HePTFE组为62.9%；p = 0.021）。两组生存率相似（47.3%对42.9%；p = 0.582），无MALE生存率也相似（69.4%对55.0%；p = 0.348）。
对于不适合血管腔内治疗的CLI患者，膝下腘动脉旁路移植术效果良好。静脉仍然是一线移植材料。
