Bloom R J, Stevick C A
Division of General and Vascular Surgery, Stanford University, Palo Alto, California.
Surg Gynecol Obstet. 1988 Jan;166(1):1-5.
The feasibility of revascularization of the lower extremity for salvage of the limb with grafts to the tibial and peroneal arteries has been well established. The results of prior reports have suggested that a failed distal bypass may convert a lower extremity amputation to a higher level than afforded by primary amputation. We reviewed all distal, tibial or peroneal artery bypasses performed at our institution during the period of March 1980 through October 1986. Fifty-three patients with 59 threatened lower extremities underwent distal bypass for salvage of the limb. No patient was excluded from review. Thirty-eight patients in the study group had diabetes, and 41 had a prior smoking history. In the postoperative period, six patients were lost to follow-up study, nine patients died, with follow-up data complete in 47 of the study group. The maximum length of follow-up study was 78 months, and the average length was 24 months. Data were examined by life table analysis with respect to cumulative salvage of the limb and graft patency. During the period of review, 12 major amputations were required (nine below-knee and three above-knee) for a cumulative salvage rate of 59 per cent. Of the distal grafts which failed (n = 27), three of 27 of the limbs required above-knee amputation. We conclude that a failed tibial or peroneal artery bypass does not preclude the possibility of salvage of the limb and does not predispose to a subsequent amputation.
采用移植至胫动脉和腓动脉的方法对下肢进行血管重建以挽救肢体的可行性已得到充分证实。先前报告的结果表明，远端旁路手术失败可能会使下肢截肢平面高于一期截肢。我们回顾了1980年3月至1986年10月期间在本机构进行的所有远端、胫动脉或腓动脉旁路手术。53例患者的59条下肢受到威胁，接受了远端旁路手术以挽救肢体。没有患者被排除在回顾之外。研究组中有38例患者患有糖尿病，41例有吸烟史。术后，6例患者失访，9例患者死亡，研究组中47例患者的随访数据完整。随访研究的最长时间为78个月，平均时间为24个月。通过生命表分析检查了有关肢体累积挽救率和移植物通畅率的数据。在回顾期间，共进行了12次大截肢（9例膝下截肢和3例膝上截肢），累积挽救率为59%。在失败的远端移植物（n = 27）中，27条肢体中有3条需要膝上截肢。我们得出结论，胫动脉或腓动脉旁路手术失败并不排除挽救肢体的可能性，也不会导致后续截肢。
