Kontopodis Nikolaos, Lioudaki Stella, Chronis Christos, Kalogerakos Paris, Lazopoulos George, Papaioannou Alexandra, Ioannou Christos V
Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece.
Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece.
Ann Vasc Surg. 2018 Apr;48:45-52. doi: 10.1016/j.avsg.2017.10.011. Epub 2017 Dec 5.
Critical limb ischemia (CLI) often results from multilevel occlusive disease. There are occasions where a patent profunda femoral artery (PFA) is the only target artery that can be used as outflow during reconstruction to bypass aortoiliac disease (AOID), with no further option for infrainguinal revascularization. We aim to report results of the use of PFA as the sole target vessel for the treatment of these patients.
This is a retrospective, single-center study including CLI patients treated during 36 months. All procedures were included regardless of inflow site. The outcomes examined were hemodynamic improvement, clinical status change, amputation-free and overall survival, and patency of the prosthesis. Univariate analysis was performed to identify possible predictors of adverse outcomes.
Twenty-three patients and 27 limbs were included (2 female, mean age 70.6). Sixteen limbs presented rest pain and 11 tissue loss. Inflow was obtained from the axillary (n = 9), contralateral femoral (n = 8), abdominal aorta (n = 2), thoracic aorta (n = 1), ipsilateral external iliac (n = 2), and contralateral external iliac artery (n = 1). Immediately postoperatively ankle-brachial index significantly increased from 0.15 (0-0.5) to 0.50 (0.25-0.9), (P-value < 0.001). Twenty-four limbs presented clinical improvement (3 minimally, 18 moderately, and 3 markedly improved) and 3 presented no change. During a mean follow-up of 15.8 (2-36) months, we recorded 4 deaths and 4 major amputations. Mean predicted overall survival and amputation-free survival were 29.8 (95% confidence interval [CI] 24.5-35.1) and 26.5 months (95% CI 21.1-31.8), respectively. Predicted primary patency was 76% at 3 years. Univariate analysis revealed significant associations only between bypass patency and limp loss (P-value = 0.021).
In the presence of CLI due to AOID and unreconstructable infrainguinal disease, the use of PFA as the sole target vessel during bypass is associated with significant rates of clinical improvement and limb salvage.
严重肢体缺血（CLI）通常由多节段闭塞性疾病引起。在某些情况下，股深动脉（PFA）通畅是重建术中绕过腹主动脉髂动脉疾病（AOID）时唯一可作为流出道的目标动脉，而腹股沟下血管重建则没有其他选择。我们旨在报告将PFA作为唯一目标血管治疗这些患者的结果。
这是一项回顾性单中心研究，纳入了36个月内接受治疗的CLI患者。无论流入部位如何，所有手术均纳入研究。检查的结果包括血流动力学改善、临床状态变化、无截肢生存率和总生存率以及假体通畅情况。进行单因素分析以确定不良结果的可能预测因素。
纳入23例患者和27条肢体（2例女性，平均年龄70.6岁）。16条肢体出现静息痛，11条肢体出现组织缺损。流入道分别来自腋动脉（n = 9）、对侧股动脉（n = 8）、腹主动脉（n = 2）、胸主动脉（n = 1）、同侧髂外动脉（n = 2）和对侧髂外动脉（n = 1）。术后即刻踝肱指数从0.15（0 - 0.5）显著提高到0.50（0.25 - 0.9），（P值<0.001）。24条肢体临床症状改善（3条轻度改善，18条中度改善，3条显著改善），3条肢体无变化。在平均15.8（2 - 36）个月的随访期间，我们记录了4例死亡和4例大截肢。平均预测总生存率和无截肢生存率分别为29.8个月（95%置信区间[CI] 24.5 - 35.1）和26.5个月（95% CI 21.1 - 31.8）。预计3年的原发性通畅率为76%。单因素分析仅显示旁路通畅与跛行消失之间存在显著关联（P值 = 0.021）。
对于因AOID导致的CLI且腹股沟下疾病无法重建的患者，在旁路手术中将PFA作为唯一目标血管与显著的临床改善率和肢体挽救率相关。
