Department of Vascular Surgery, Albany Medical College, Albany Medical Center Hospital, Albany, NY.
Department of Vascular Surgery, Albany Medical College, Albany Medical Center Hospital, Albany, NY.
J Vasc Surg. 2021 Sep;74(3):798-803. doi: 10.1016/j.jvs.2021.02.034. Epub 2021 Mar 5.
Infrainguinal bypass performed after previous prosthetic inflow reconstruction offers a choice of where to perform the proximal anastomosis. The hood of a previous inflow bypass might be technically easier to isolate during reoperative surgery. However, the more distal native artery might offer better patency to the outflow revascularization. The purpose of the present study was to compare the outcomes of infrainguinal bypass using the hood of a previous inflow bypass vs the native artery as the inflow source.
A single vascular group's database was queried for all cases of infrainguinal bypass performed after previous prosthetic inflow bypass to a femoral artery from January 2006 to December 2016. The demographics, indications, operative details, and long-term results were recorded and analyzed. Two groups were compared stratified by the location of the proximal anastomosis for the distal bypass. In one group, the inflow source for the distal bypass was from the hood of a previous inflow graft (prosthetic). In the second group, the distal native arterial tree was used as the inflow source. A subset analysis of the patency of the distal bypass was also performed between the two groups for those in which the previous inflow reconstruction had become occluded. Patency was calculated using the Kaplan-Meier method.
A total of 197 patients had undergone infrainguinal bypass after previous inflow bypass from 2006 to 2016. Of the 197 procedures, 59 (30%) had used the hood of the previous bypass as the inflow source (prosthetic group) and 138 (70%) had used the native artery distal to the hood of the inflow bypass as the inflow source (native group). The indications were similar between the two groups. The two groups had a similar proportion of men and a similar incidence of hypertension, hyperlipidemia, coronary artery disease, tobacco use, and renal disease. The previous inflow procedures were also similar between the two groups. The native artery used for the inflow source in the native group was the profunda femoris in 80 (58%), common femoral artery in 51 (37%), and superficial femoral artery in 7 (5.1%). Patency was significantly greater for the native group at 1 year (91% vs 75%; P = .0221). Also, the patency after inflow bypass occlusion significantly favored the native group at 1 year (87% vs 40%; P = .0035).
Infrainguinal bypass performed after previous ipsilateral inflow bypass offers the option of using the hood of the bypass or a native artery as the inflow source. The present study demonstrated greater patency rates when using the distal native artery as the inflow source. The native artery option also offered continued patency when the inflow bypass occluded.
在先前的人造血管流入重建后进行的下肢旁路手术为进行近端吻合提供了选择。先前的流入旁路的罩可能在再次手术中更容易被隔离。然而，更远端的原生动脉可能为流出再血管化提供更好的通畅性。本研究的目的是比较使用先前流入旁路的罩作为流入源与使用原生动脉作为流入源进行下肢旁路的结果。
对 2006 年 1 月至 2016 年 12 月期间，因先前人造血管流入至股动脉的旁路手术后，所有进行下肢旁路手术的患者进行了单一血管组数据库查询。记录并分析了患者的人口统计学、适应证、手术细节和长期结果。根据远端旁路的近端吻合位置，将两组进行分层比较。在一组中，远端旁路的流入源来自先前流入移植物的罩（人造）。在第二组中，使用远端原生动脉树作为流入源。对于那些先前的流入重建已经闭塞的患者，还对两组之间的远端旁路通畅性进行了亚组分析。通畅性使用 Kaplan-Meier 方法计算。
2006 年至 2016 年期间，共有 197 例患者在先前的流入旁路手术后接受了下肢旁路手术。在 197 例手术中，59 例（30%）使用先前旁路的罩作为流入源（人造组），138 例（70%）使用流入旁路罩下方的原生动脉作为流入源（原生组）。两组的适应证相似。两组中男性的比例相似，高血压、高血脂、冠心病、吸烟和肾脏疾病的发病率也相似。两组的先前流入手术也相似。在原生组中，用于流入源的原生动脉是股深动脉 80 例（58%）、股总动脉 51 例（37%）和股浅动脉 7 例（5.1%）。在 1 年时，原生组的通畅率明显更高（91% vs 75%；P=0.0221）。此外，在流入旁路闭塞后，1 年时原生组的通畅率也明显更高（87% vs 40%；P=0.0035）。
在先前同侧流入旁路手术后进行的下肢旁路手术可选择使用旁路的罩或原生动脉作为流入源。本研究表明，使用远端原生动脉作为流入源时，通畅率更高。当流入旁路阻塞时，原生动脉的选择也提供了持续的通畅性。
