Betz Thomas, Ingolf Toepel, Markus Steinbauer, Florian Zeman, Christian Uhl
Department of Vascular Surgery, Barmherzige Brüder Hospital, Regensburg, Germany.
Department of Vascular Surgery, Barmherzige Brüder Hospital, Regensburg, Germany.
Ann Vasc Surg. 2022 Feb;79:191-200. doi: 10.1016/j.avsg.2021.06.046. Epub 2021 Oct 10.
To investigate the long-term outcomes of femoropopliteal bypass surgery in patients with chronic limb-threatening ischemia (CLTI) and TransAtlantic Inter-Society Consensus II (TASC II), type D (TASC D) femoropopliteal disease.
A retrospective analysis was performed for all consecutive patients undergoing above-knee (AK) femoropopliteal bypass surgery at an academic vascular centre between January 2007 and March 2019. Patients with claudication (IC) and patients with CLTI were included. Patency rates and freedom from major adverse limb events (MALE) after 5 years were analysed.
In total, 432 femoropopliteal grafts were performed. Indications for surgery were claudication and CLTI in 232 (53.7%) and 200 (46.3%) patients, respectively. Graft material was autologous vein in 186 patients (43.1%), polytetrafluoroethylene (PTFE) in 128 patients (29.6%), and heparin-bonded expanded polytetrafluoroethylene (HePTFE) in 118 patients (27.3%). At the 5-year follow-up, the primary patency rate was 58.1% and 58.3% in patients with CLTI and claudication, respectively. Secondary patency rates were 74.1% and 68.6%, respectively. Freedom from MALE was 64.5% and 61.9%, respectively. Analyses of graft material in the CLTI group showed that, at 5 years, autologous vein grafts had better long-term patency rates than PTFE and HePTFE grafts. At 5 years, the primary and secondary patency rate for autologous vein grafts were 63.2% (P= 0.324) and 83.2% (P = 0.020), respectively. Freedom from MALE was 72.0% with the use of autologous vein grafts, 47.9% using PTFE and, 52.9% using HePTFE, respectively (P= 0.021).
Our study shows that femoropopliteal bypass surgery in patients with TASC D lesions is safe and effective in the long term. Autologous vein grafts remain the first choice for patients with CLTI, also for bypasses in AK position. However, prosthetic grafts in AK the position are an acceptable alternative for revascularisation when the saphenous vein is not available.
探讨慢性肢体威胁性缺血（CLTI）患者及跨大西洋两岸血管外科学会（TASC）II D型（TASC D）股腘动脉疾病患者行股腘动脉搭桥手术的长期疗效。
对2007年1月至2019年3月在某学术血管中心连续接受膝上（AK）股腘动脉搭桥手术的所有患者进行回顾性分析。纳入间歇性跛行（IC）患者和CLTI患者。分析5年后的通畅率和无主要肢体不良事件（MALE）情况。
共进行了432例股腘动脉移植手术。手术适应证分别为间歇性跛行和CLTI的患者有232例（53.7%）和200例（46.3%）。186例（43.1%）患者使用自体静脉作为移植材料，128例（29.6%）患者使用聚四氟乙烯（PTFE），118例（27.3%）患者使用肝素涂层的膨体聚四氟乙烯（HePTFE）。在5年随访时，CLTI患者和间歇性跛行患者的一期通畅率分别为58.1%和58.3%。二期通畅率分别为74.1%和68.6%。无MALE的比例分别为64.5%和61.9%。CLTI组移植材料分析显示，5年时自体静脉移植物的长期通畅率优于PTFE和HePTFE移植物。5年时，自体静脉移植物的一期和二期通畅率分别为63.2%（P = 0.324）和83.2%（P = 0.020）。使用自体静脉移植物时无MALE的比例为72.0%，使用PTFE时为47.9%，使用HePTFE时为52.9%（P = 0.021）。
我们的研究表明，TASC D病变患者行股腘动脉搭桥手术长期来看是安全有效的。自体静脉移植物仍是CLTI患者的首选，对于AK位搭桥也是如此。然而，当大隐静脉不可用时AK位的人工血管移植物是血管重建的可接受替代方案。
