Illuminati Giulio, Calio' Francesco G, Pizzardi Giulia, Pasqua Rocco, Masci Federica, Frezzotti Francesca, Palumbo Piergaspare, Vietri Francesco
The Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy.
Division of Vascular Surgery, Sant'Anna Hospital, Catanzaro, Italy.
Ann Vasc Surg. 2018 Feb;47:188-194. doi: 10.1016/j.avsg.2017.09.010. Epub 2017 Sep 22.
When the common femoral artery is not accessible for infrainguinal bypass grafting, the profunda femoris artery (PFA) can be a valuable alternative inflow source for distal arterial revascularization. The purpose of this retrospective study was to evaluate the results of infrageniculate bypass grafting via the PFA as inflow source for critical limb ischemia.
Between 1994 and 2016, 68 patients, 51 men of a mean age of 74 years, underwent an infrageniculate arterial bypass grafting for critical limb ischemia, using the PFA as inflow site. PFA was exposed at the Scarpa's triangle in 38 patients (56%) and at its medio-crural segment in 30 patients (44%). The distal anastomosis was performed on the infragenicular popliteal artery in 33 patients (48%), the peroneal artery in 14 patients (20%), the tibioperoneal trunk in 8 patients (12%), the posterior tibial artery in 8 patients (12%), and the dorsalis pedis artery in 5 patients (8%). The graft material consisted of a reversed great saphenous vein (GSV) in 62 patients (91%) and a 6-mm polytetrafluoroethylene graft in 6 patients (9%). The median duration of follow-up was 51 months (range, 6-72 months). As main results, postoperative mortality and morbidity, overall late patients' survival, primary grafts' patency, and limb salvage rate were considered.
Operative mortality and morbidity were 3% and 4%, respectively. Overall patients' survival, primary patency and limb salvage rate, at 36 and 60 months were, respectively, 62% and 53%, 66% and 59%, and 92% and 77%.
The PFA, both exposed at the Scarpa's triangle and at mid-thigh, is an excellent inflow source for infrageniculate revascularizations. It should remain an important part of the technical armamentarium of vascular surgeons, even in the endovascular era.
当无法通过股总动脉进行膝下旁路移植时，股深动脉（PFA）可作为远端动脉血运重建的重要替代流入源。本回顾性研究的目的是评估以PFA为流入源进行膝下旁路移植治疗严重肢体缺血的结果。
1994年至2016年间，68例患者（51例男性，平均年龄74岁）因严重肢体缺血接受了以PFA为流入部位的膝下动脉旁路移植术。38例患者（56%）在斯卡帕三角暴露PFA，30例患者（44%）在其小腿中段暴露。33例患者（48%）的远端吻合口位于腘动脉膝下，14例患者（20%）位于腓动脉，8例患者（12%）位于胫腓干，8例患者（12%）位于胫后动脉，5例患者（8%）位于足背动脉。移植物材料包括62例患者（91%）使用的大隐静脉（GSV）反转和6例患者（9%）使用的6毫米聚四氟乙烯移植物。中位随访时间为51个月（范围6 - 72个月）。主要结果包括术后死亡率和发病率、患者总体远期生存率、原发性移植物通畅率和肢体挽救率。
手术死亡率和发病率分别为3%和4%。36个月和60个月时患者总体生存率、原发性通畅率和肢体挽救率分别为62%和53%、66%和59%、92%和77%。
无论是在斯卡帕三角还是大腿中部暴露的PFA，都是膝下血运重建的良好流入源。即使在血管腔内治疗时代，它仍应是血管外科医生技术手段的重要组成部分。
