Clinic of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Pruefeningerstrasse 81, Regensburg, 93049, Germany.
Clinic of Vascular Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany.
Scand J Surg. 2021 Sep;110(3):400-406. doi: 10.1177/1457496920907733. Epub 2020 Feb 25.
Arteriosclerotic disease of the common femoral artery can be treated by surgical or endovascular intervention. Elderly patients are said to have a worse outcome if treated by surgical means; however, data to support this theory are missing.
Retrospective analysis of all patients who underwent common femoral artery endarterectomy between March 2007 and July 2018 in our clinic. Group 1 included all patients <80 years and Group 2 included all patients ⩾80 years. Endpoints were patency rates, limb salvage, and overall survival.
During this time period, 977 common femoral artery endarterectomies were performed. Indication was claudication in 61.5% and critical limb ischemia in 38.5%. Group 1 included 805 cases (82.4%) and Group 2 included 172 cases (17.6%). Thirty-day mortality was 2.7% (Group 1 = 1.6% versus Group 2 = 7.6%; < 0.001) and 30-day major amputation was 1.1% (Group 1 = 0.7% versus Group 2 = 2.9%; = .043). Primary patency and secondary patency were 84.2% and 96.8%, respectively, after 7 years. Limb salvage (93.7%, Group 1 = 94.1% versus Group 2 = 91.8%; = .088) and overall survival (52.0%, Group 1 = 59.1% versus Group 2 = 15.7%; = .006) were significantly different after the same time period. Multivariable analysis showed female gender to be a risk factor for loss of primary patency. Age ⩾ 80 years and ulcer or gangrene were risk factors for death. Statin use was beneficial to survival.
Common femoral artery endarterectomy is a safe procedure with excellent long-term results. Octogenarians have an increased risk for perioperative mortality and major amputation.
股总动脉粥样硬化性疾病可通过手术或血管内介入治疗。有人说，老年患者如果采用手术治疗，其预后较差，但缺乏支持这一理论的数据。
回顾性分析 2007 年 3 月至 2018 年 7 月期间在我院行股总动脉内膜切除术的所有患者。第 1 组包括所有年龄<80 岁的患者，第 2 组包括所有年龄 ⩾80 岁的患者。终点为通畅率、肢体挽救率和总生存率。
在此期间，共行 977 例股总动脉内膜切除术。适应证为跛行 61.5%，严重肢体缺血 38.5%。第 1 组包括 805 例（82.4%），第 2 组包括 172 例（17.6%）。30 天死亡率为 2.7%（第 1 组 1.6%，第 2 组 7.6%； ⁇ <0.001），30 天主要截肢率为 1.1%（第 1 组 0.7%，第 2 组 2.9%； ⁇ =0.043）。7 年后，原发性通畅率和继发性通畅率分别为 84.2%和 96.8%。同样在 7 年后，肢体挽救率（93.7%，第 1 组 94.1%，第 2 组 91.8%； ⁇ =0.088）和总生存率（52.0%，第 1 组 59.1%，第 2 组 15.7%； ⁇ =0.006）差异有统计学意义。多变量分析显示，女性是原发性通畅率丧失的危险因素。年龄 ⁇ ⁇ 80 岁和溃疡或坏疽是死亡的危险因素。他汀类药物的使用有利于生存。
股总动脉内膜切除术是一种安全的手术，具有良好的长期效果。80 岁以上的老年人围手术期死亡率和主要截肢率增加。
