Waezi Narges, Saha Shekhar, Bougioukas Ioannis, Emmert Alexander, Danner Bernhard Christoph, Baraki Hassina, Kutschka Ingo, Zenker Dieter, Stojanovic Tomislav, Jebran Ahmad Fawad
Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen.
Department of Cardiothoracic Surgery, Voelklingen Heart Centre, Völklingen.
Medicine (Baltimore). 2018 Oct;97(40):e12449. doi: 10.1097/MD.0000000000012449.
The prosthetic surgical above-knee bypass (pAKB) is a standard therapy in superficial femoral artery (SFA) occlusive disease in absence of suitable vein. Viabahn graft has been established as a promising alternative. Since limited comparative data are available, we conducted a retrospective study to compare long-term outcomes of these 2 therapies in a real-world setting.Records of 52 patients (60 limbs), who were treated by pAKB (29 limbs) or Viabahn (31 limbs) were reviewed. Patients were followed up by clinical assessment, physical examination, and resting ankle brachial index (ABI) after 3, 6, 12 months and yearly thereafter. Long-term data were available for 97% in the Viabahn and 93% for pAKB after 73 ± 3.7 months (mean ± standard error [SE]).Long-term primary and secondary patencies in Viabahn group were 40% and 70%, respectively, after 63 ± 2.8 months (mean ± SE). Total lesion length was 19 ± 11.06 cm (mean ± SE), graft size was 6 ± 0.72 mm (mean ± SE). Hospital stay was 4.8 ± 0.72 days (mean ± SE). Limb salvage was achieved in 90%. Patients in the pAKB group showed a total lesion length of 24.39 ± 1.97 cm (mean ± SE), graft size was 7 ± 0.99 mm (mean ± SE). Long-term analysis after 83 ± 6.8 months (mean ± SE) revealed a primary patency of 78% with a secondary patency of 94%. Hospital stay was 10.4 ± 1.27 days (mean ± SE). Limb salvage was ensured in 97%. Long-term primary patency was lower for Viabahn (P = .044), secondary patency (P = .245), and leg salvage (P = .389) were not significantly different. However, hospital stay was shorter (P = .0002) for Viabahn.Long-term analysis of Viabahn revealed a significantly lower primary patency, a similar secondary patency, limb salvage, and significantly shorter hospital stay when compared with pAKB. Our data suggest that pAKB is still a valuable option in patients suitable for an open operation. However, Viabahn can be used as a less invasive treatment in high risk patients.
人工血管膝上搭桥术（pAKB）是在没有合适静脉的情况下治疗股浅动脉（SFA）闭塞性疾病的标准疗法。Viabahn移植物已被确立为一种有前景的替代方案。由于可用的比较数据有限，我们进行了一项回顾性研究，以比较这两种疗法在实际临床环境中的长期疗效。我们回顾了52例患者（60条肢体）的记录，这些患者接受了pAKB治疗（29条肢体）或Viabahn治疗（31条肢体）。在术后3、6、12个月及之后每年对患者进行临床评估、体格检查和静息踝肱指数（ABI）随访。在平均73±3.7个月（均值±标准误[SE]）后，Viabahn组97%的患者有长期数据，pAKB组为93%。Viabahn组在平均63±2.8个月（均值±SE）后的长期一期通畅率和二期通畅率分别为40%和70%。病变总长度为19±11.06 cm（均值±SE），移植物直径为6±0.72 mm（均值±SE）。住院时间为4.8±0.72天（均值±SE）。保肢率为90%。pAKB组患者的病变总长度为24.39±1.97 cm（均值±SE），移植物直径为7±0.99 mm（均值±SE）。在平均83±6.8个月（均值±SE）后的长期分析显示，一期通畅率为78%，二期通畅率为94%。住院时间为10.4±1.27天（均值±SE）。保肢率为97%。Viabahn组的长期一期通畅率较低（P = 0.044），二期通畅率（P = 0.245）和保肢率（P = 0.389）无显著差异。然而，Viabahn组的住院时间较短（P = 0.0002）。与pAKB相比，Viabahn的长期分析显示一期通畅率显著较低，二期通畅率、保肢率相似，且住院时间显著较短。我们的数据表明，pAKB对于适合开放手术的患者仍然是一个有价值的选择。然而，Viabahn可用于高风险患者的微创治疗。
