The Vascular Group, Albany Medical College, Albany Medical Center Hospital, Albany, NY.
The Vascular Group, Albany Medical College, Albany Medical Center Hospital, Albany, NY.
J Vasc Surg. 2020 Mar;71(3):880-888. doi: 10.1016/j.jvs.2019.05.055. Epub 2019 Sep 26.
Aggressive endovascular interventions for patients without adequate full-length venous conduit have gained popularity. The purpose of this study is to evaluate the outcomes of spliced vein bypass (SVB) as primary treatment versus treatment after failed endovascular intervention (endovascular SVB [ESVB]) for infrainguinal revascularization.
A retrospective analysis of a single vascular group's database of all SVBs was queried for demographics, indications, intraoperative details, and outcomes. Exclusion criteria included acute ischemia, aneurysm, dual outflow, bypass revisions, and patients lost to immediate follow-up. SPSS software was used for statistical analysis.
Two hundred thirty-five infrainguinal SVBs were performed between January 2011 and March 2017. There were 182 SVB (77%) and 53 ESVB (23%) with a mean follow-up of 488 days (range, 1-2140). Demographics between the SVB and ESVB groups were similar in all categories recorded: diabetes, hypertension, coronary artery disease, current smoker, chronic obstructive pulmonary disease, hyperlipidemia, and renal disease (P = .29). Indications for bypass were not statistically significant between SVB and ESVB (P = .48). The study included Rutherford class 3 (14 vs 2), class 4 (51 vs 20), class 5 (67 vs 18), and class 6 (50 vs 13). Inflow was grouped into iliac (2.6%), femoral (88%), and popliteal (9.8%). Outflow arteries were grouped into below knee popliteal (14.9%) and infrapopliteal (85.1%). Inflow and outflow arteries, as well as number of spliced pieces per bypass were not different between groups. Major amputation rates were not different between SVB and ESVB for the entire study period. There was no statistical difference with patency outcomes based on Kaplan-Meier survival analysis (P = .84).
An aggressive endovascular first strategy for treatment of patients without adequate autogenous conduit seems to offer benefit without negatively affecting future bypass options. SVB patency and major amputation rates in this series were not affected by a prior endovascular treatment.
对于没有足够长的静脉导管的患者，积极的血管内介入治疗已经越来越受欢迎。本研究的目的是评估拼接静脉旁路（SVB）作为原发性治疗与血管内治疗失败后的治疗（血管内 SVB[ESVB]）在下肢血运重建中的结果。
对一个单血管组的所有 SVB 数据库进行回顾性分析，以获取人口统计学、适应证、术中细节和结果。排除标准包括急性缺血、动脉瘤、双重流出、旁路修正以及在随访中丢失的患者。使用 SPSS 软件进行统计分析。
2011 年 1 月至 2017 年 3 月期间，共进行了 235 例下肢 SVB。其中 182 例 SVB（77%）和 53 例 ESVB（23%），平均随访 488 天（范围 1-2140 天）。SVB 和 ESVB 组的人口统计学在所有记录的类别中均相似：糖尿病、高血压、冠心病、现吸烟者、慢性阻塞性肺疾病、高脂血症和肾病（P=0.29）。旁路适应证在 SVB 和 ESVB 之间无统计学差异（P=0.48）。研究包括 Rutherford 分级 3（14 例比 2 例）、4 级（51 例比 20 例）、5 级（67 例比 18 例）和 6 级（50 例比 13 例）。流入血管分为髂内（2.6%）、股总（88%）和腘动脉（9.8%）。流出动脉分为膝下腘动脉（14.9%）和膝下动脉（85.1%）。两组间旁路的拼接血管数量和拼接片数无差异。整个研究期间，SVB 和 ESVB 的主要截肢率无差异。基于 Kaplan-Meier 生存分析，通畅率结果无统计学差异（P=0.84）。
对于没有足够自体导管的患者，积极的血管内初始治疗策略似乎有益，而不会对未来的旁路选择产生负面影响。本系列中 SVB 的通畅率和主要截肢率不受先前血管内治疗的影响。
