Tsuji Yoshihiko, Kitano Ikuro, Sugimoto Koji
Department of Surgery, Shinsuma General Hospital, Kobe,Hyogo, Japan.
Department of Radiology, Kobe University Hospital, Kobe,Hyogo, Japan.
Ann Vasc Dis. 2017 Sep 25;10(3):223-8. doi: 10.3400/avd.oa.17-00049.
: The aim of this study was to evaluate outcomes of combined popliteal-to-distal bypass and endovascular treatment (EVT) for femoropopliteal lesions in patients with critical limb ischemia (CLI). : We reviewed data of 14 CLI patients who were treated by popliteal-to-distal bypass combined with femoropopliteal EVT. The femoropopliteal lesions included 3 TASC II-A, 8 TASC II-B, and 3TASC II-C but no TASC II-D, and balloon dilatation was performed in 9 cases and a stent was placed in 5 cases. The saphenous vein graft was used in all bypasses, and the target arteries were the dorsalis pedis artery in 12 cases and the posterior tibial artery in 2 cases. : At 12 and 24 months, primary patency rates were both 79%, primary assisted and secondary patency rates were both 93%, limb salvage rates were both 93%, and survival rates were 92% and 84%, respectively. Restenosis after femoropopliteal EVT occurred in 2 cases, and both were successfully revised by additional endovascular balloon dilatation. : Combined popliteal-to-distal bypass and femoropopliteal EVT might be a useful therapeutic option for appropriately selected CLI patients. Intensive follow-up for endovascular treated lesions and vein graft is mandatory.
本研究的目的是评估腘动脉至远端旁路移植术联合血管内治疗（EVT）对严重肢体缺血（CLI）患者股腘动脉病变的治疗效果。我们回顾了14例接受腘动脉至远端旁路移植术联合股腘动脉EVT治疗的CLI患者的数据。股腘动脉病变包括3例TASC II - A、8例TASC II - B和3例TASC II - C，但无TASC II - D，其中9例行球囊扩张，5例行支架置入。所有旁路移植均采用大隐静脉，12例的靶动脉为足背动脉，2例为胫后动脉。在12个月和24个月时，一期通畅率均为79%，一期辅助通畅率和二期通畅率均为93%，肢体挽救率均为93%，生存率分别为92%和84%。股腘动脉EVT术后2例发生再狭窄，均通过再次血管内球囊扩张成功修复。腘动脉至远端旁路移植术联合股腘动脉EVT可能是适合的CLI患者的一种有效治疗选择。对血管内治疗的病变和静脉移植物进行密切随访是必要的。
