Rother Ulrich, Gruber Marc, Behrendt Christian-Alexander, Günther Josefine, Lang Werner, Meyer Alexander
Department of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.
Department of Vascular Medicine, Research Group GermanVasc, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Front Surg. 2022 Feb 22;9:811126. doi: 10.3389/fsurg.2022.811126. eCollection 2022.
Due to an increasing life expectancy, more and more patients experience the failure of peripheral arterial revascularization. This study aims to investigate patients treated for the failure of infra-inguinal bypass grafts, and to investigate the interaction of different bypass materials [great saphenous vein (GSV) and polytetrafluoroethylene (PTFE)] and the further outcome.
Retrospective single-center analysis of consecutive patients treated for acute or chronic occlusion of infra-inguinal bypasses at a university hospital was conducted. Hospitalizations from 1st January 2010 through 31st December 2019 were included. Perioperative parameters from the index operation including graft material (prosthetic vs. autologous) were assessed. After bypass occlusion, the grade of ischemia, as well as the distal landing zone of the redo bypass compared with the primary bypass was investigated.
In this study, 158 (65% men and 35% women with a m mean age of 70.5 years) eligible patients were included (57% vein and 42% prosthetic bypass grafts). After graft occlusion, 47% of the patients presented with symptoms of acute limb-threatening ischemia, 53% with symptoms of chronic leg ischemia. The rate of acute limb-threatening ischemia was significantly higher when prosthetic graft material was used during the index operation ( =0.016). Additionally, in case of reoperation, the landing zone of the redo bypass was significantly more distally located after occlusion of prosthetic bypass graft ( = 0.014).
Occlusions of prosthetic bypass grafts were associated with significantly higher rates of acute symptoms compared with vein grafts. Additionally, a shift to a more distal landing zone was recognized after the failure of a prosthetic bypass graft during the redo bypass operation.
由于预期寿命的增加，越来越多的患者经历外周动脉血运重建失败。本研究旨在调查接受腹股沟下旁路移植失败治疗的患者，并研究不同旁路材料[大隐静脉（GSV）和聚四氟乙烯（PTFE）]之间的相互作用以及进一步的结果。
对一家大学医院连续接受腹股沟下旁路急性或慢性闭塞治疗的患者进行回顾性单中心分析。纳入2010年1月1日至2019年12月31日的住院病例。评估包括移植材料（人工血管与自体血管）在内的首次手术的围手术期参数。在旁路闭塞后，调查缺血程度以及再次旁路手术与初次旁路手术相比的远端着陆区。
本研究纳入了158例符合条件的患者（65%为男性，35%为女性，平均年龄70.5岁）（57%为静脉旁路移植，42%为人工血管旁路移植）。移植血管闭塞后，47%的患者出现急性肢体威胁性缺血症状，53%的患者出现慢性腿部缺血症状。在首次手术中使用人工血管移植材料时，急性肢体威胁性缺血的发生率显著更高（P = 0.016）。此外，在再次手术的情况下，人工血管旁路移植闭塞后再次旁路手术的着陆区明显更靠远端（P = 0.014）。
与静脉移植相比，人工血管旁路移植闭塞与急性症状的发生率显著更高相关。此外，在再次旁路手术中，人工血管旁路移植失败后可观察到着陆区向更远端转移。
