Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, CA.
Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, CA.
Ann Vasc Surg. 2022 Oct;86:184-189. doi: 10.1016/j.avsg.2022.04.023. Epub 2022 Apr 23.
Although the majority of patients presenting with symptomatic peripheral arterial disease (PAD) are treated with the endovascular first approach, a significant number of these patients still require open bypass because of the extent of atherosclerotic burden or failure of the endovascular therapy. However, data available on the outcomes of femoropoliteal bypass in the contemporary era of PAD management is scarce. In this study, we evaluate realworld mid-term outcomes of femoropopliteal bypass for PAD.
We identified all patients who underwent open femoropopliteal revascularization with autogenous vein conduits for PAD at one institution between January 2012 and December 2017. Main endpoints included primary patency, amputation-free survival, overall survival, and limb salvage at 2 years. Outcomes were defined as per the Society for Vascular Surgery standards. Descriptive statistics were performed using univariable analyses including the mean and standard deviation for continuous variables and frequency and percentage for categorical variables. Event-free survival rates were estimated using Kaplan-Meier methods.
There were 129 patients who received autogenous vein grafts. Median follow-up was 19 months (interquartile rangeIQR 11-26). Patients were predominantly male (59.7%), white (72.9%) with a mean age of 65 ± 11 years. The indications for surgery were disabling claudication in 36.4% of patients (n = 47) and chronic limb threatening ischemia (CLTI) in 63.6% (n = 82). Most patients had Trans-Atlantic Inter-Society Consensus C or D lesions (n = 81, 62.8%). Seventeen cases (16.3%) were redoing bypasses. Arm veins and spliced vein conduits were used in 12% and 7%, respectively. In 66% of procedures, the distal anastomosis was below the knee. Primary patency estimates at 6 months, 1 year and 2 years were 81.3%, 68.6% and 59.2%, respectively. Amputation-free survival rates were 93.4%, 88% and 82.1% at 6 months, 1 year and 2 years, respectively. Limb salvage rates among patients with CLTI were 93.4%, 90.4% and 87.2% at 6 months, 1 year and 2 years, respectively. Overall survival was 97.5%, 92.1% and 87.8% at 6 months, 1 year and 2 years, respectively.
In this contemporary cohort of patients, femoropopliteal bypass showed lower patency than previously described. The fact that bypass surgery is performed on sicker patients with more extensive disease in the endovascular era might explain this discrepancy. However, our results demonstrated satisfactory patency and limb salvage rates and suggest that vein should always be used if available.
尽管大多数出现症状性外周动脉疾病（PAD）的患者都采用血管内初次治疗方法，但由于动脉粥样硬化负担的程度或血管内治疗失败，仍有相当数量的患者需要进行开放旁路手术。然而，在当前 PAD 管理时代，关于股腘旁路手术的结果数据却很少。在这项研究中，我们评估了真实世界中股腘旁路手术治疗 PAD 的中期结果。
我们在一家机构确定了 2012 年 1 月至 2017 年 12 月期间接受自体静脉移植物治疗 PAD 的所有开放股腘旁路手术患者。主要终点包括 2 年时的一期通畅率、免于截肢生存率、总生存率和肢体存活率。结果按血管外科学会的标准定义。采用单变量分析进行描述性统计，包括连续变量的均值和标准差以及分类变量的频率和百分比。使用 Kaplan-Meier 方法估计无事件生存率。
共有 129 名患者接受了自体静脉移植物。中位随访时间为 19 个月（四分位距 IQR 11-26）。患者主要为男性（59.7%）、白人（72.9%），平均年龄为 65±11 岁。手术指征为有症状性间歇性跛行的患者占 36.4%（n=47），慢性肢体缺血性疾病（CLTI）占 63.6%（n=82）。大多数患者为 Trans-Atlantic Inter-Society Consensus C 或 D 级病变（n=81，62.8%）。17 例（16.3%）为再旁路手术。臂静脉和拼接静脉移植物分别占 12%和 7%。在 66%的手术中，远端吻合口位于膝关节以下。6 个月、1 年和 2 年时的一期通畅率估计值分别为 81.3%、68.6%和 59.2%。6 个月、1 年和 2 年时的免于截肢生存率分别为 93.4%、88%和 82.1%。CLTI 患者的肢体存活率分别为 6 个月、1 年和 2 年时的 93.4%、90.4%和 87.2%。6 个月、1 年和 2 年时的总生存率分别为 97.5%、92.1%和 87.8%。
在这个当代患者队列中，股腘旁路手术的通畅率低于之前描述的结果。在血管内治疗时代，旁路手术针对的是病情更严重、疾病更广泛的患者，这可能解释了这种差异。然而，我们的结果显示出了令人满意的通畅率和肢体存活率，表明如果有静脉可利用，应始终使用静脉。
