Patel K R, Semel L, Clauss R H
New York Medical College, Metropolitan Hospital Center, NY 10029.
J Vasc Surg. 1988 Apr;7(4):531-7.
A prospective study was performed between May 1982 and March 1987 to assess the value of intraoperative prereconstruction angiography (IPA) in limb salvage. Eligibility was limited to patients with rest pain, ischemic ulcers, or gangrene limited to the toes: only candidates for infrapopliteal bypass were included. Seventy-eight such patients were examined with preoperative angiography. Delayed films, selective catheterization, reactive hyperemia, or vasodilators were used routinely. In only 11 of 78 patients (14%) was the runoff adequately visualized, demonstrating the tibial vessels and the pedal arch. The remaining 67 patients (86%) (with nonreconstructable disease by currently accepted outflow criteria) had surgical exposure of a tibial or pedal artery for IPA. In 56 of these patients (84%) good runoff was demonstrated and bypass was performed. The reconstruction rate was 86% (67 of 78 patients), significantly higher than the 33% rate reported by others. The operative mortality rate was 2.8% (2 of 78 patients). We concluded that in severe ischemia preoperative angiography is often inadequate in demonstrating runoff, even with adjunctive measures to dilate the outflow vessels. IPA through the tibial and pedal vessels eliminates all of the proximal vascular resistance, thereby providing a "completion angiogram" before reconstruction. This in turn extends reconstructability to many patients who would otherwise undergo primary amputation.
1982年5月至1987年3月期间进行了一项前瞻性研究，以评估术中重建前血管造影（IPA）在保肢中的价值。入选标准仅限于有静息痛、缺血性溃疡或仅累及脚趾的坏疽患者：仅纳入腘动脉以下旁路手术的候选者。78例此类患者接受了术前血管造影检查。常规使用延迟片、选择性导管插入术、反应性充血或血管扩张剂。78例患者中只有11例（14%）的流出道显影良好，显示出胫血管和足弓。其余67例患者（86%）（根据目前公认的流出道标准为不可重建疾病）接受了胫动脉或足动脉的手术暴露以进行IPA。其中56例患者（84%）显示流出道良好并进行了旁路手术。重建率为86%（78例患者中的67例），显著高于其他人报告的33%。手术死亡率为2.8%（78例患者中的2例）。我们得出结论，在严重缺血的情况下，即使采取辅助措施扩张流出道血管，术前血管造影也常常无法充分显示流出道。通过胫血管和足血管进行的IPA消除了所有近端血管阻力，从而在重建前提供了一张“完整血管造影照片”。这反过来又将可重建性扩展到许多否则将接受一期截肢的患者。
