Kim Young, Thangappan Karthik, DeCarlo Charles S, Jessula Samuel, Majumdar Monica, Patel Shiv S, Zacharias Nikolaos, Mohapatra Abhisekh, Dua Anahita
Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
J Surg Res. 2022 Nov;279:323-329. doi: 10.1016/j.jss.2022.06.021. Epub 2022 Jul 6.
Outcomes after femoropopliteal bypass for intermittent claudication (IC) remain unclear in the endovascular era.
A multi-institutional database was retrospectively queried for all femoropopliteal bypass procedures performed between 1995 and 2020. Demographics, operative details, and outcomes were documented. A statistical analysis included Kaplan-Meier curves and Cox proportional hazards ratios (HR).
A total of 282 patients underwent femoropopliteal bypass surgery for IC. Median age was 68 y (interquartile range, 61-73 y). Bypass conduits included great saphenous vein (GSV) (48.2%), prosthetic grafts (48.9%), and non-GSV autogenous grafts (2.8%). Distal bypass target was above-knee in 62.1% and below-knee in 37.9% of patients. The most common postoperative complications were wound infections (14.2%) followed by unplanned 30-d hospital readmissions (12.4%). Mortality rates were low at 0.4% (30 d) and 3.2% (1 y). Five-year primary patency rates trended highest for claudicants undergoing above-knee bypass with GSV conduit (log-rank P = 0.065). Five-year amputation-free survival rates were highest using GSV conduit regardless of distal bypass target (log-rank P = 0.017). On a multivariable analysis, age (HR 1.02 [1.00-1.04], P = 0.023) and active smoking (HR 1.48 [1.06-2.06], P = 0.021) were identified as risk factors for diminished primary graft patency. Risk factors for amputation-free survival included age (HR 1.03 [1.01-1.05], P < 0.001) and GSV conduit type (HR 0.65 [0.46-0.90], P = 0.011).
Femoropopliteal bypass among claudicants is associated with high rates of wound infection and hospital readmission. Active smoking portends worse outcomes in this population. These data may inform clinical decision-making regarding surgical intervention for claudication in the endovascular era.
在血管内治疗时代，股腘动脉旁路移植术治疗间歇性跛行（IC）后的结局仍不明确。
对一个多机构数据库进行回顾性查询，以获取1995年至2020年间进行的所有股腘动脉旁路移植手术。记录人口统计学资料、手术细节和结局。统计分析包括Kaplan-Meier曲线和Cox比例风险比（HR）。
共有282例患者因IC接受了股腘动脉旁路移植手术。中位年龄为68岁（四分位间距，61 - 73岁）。旁路血管包括大隐静脉（GSV）（48.2%）、人工血管移植物（48.9%）和非GSV自体移植物（2.8%）。62.1%的患者远端旁路目标位于膝上，37.9%的患者位于膝下。最常见的术后并发症是伤口感染（14.2%），其次是计划外30天再次入院（12.4%）。死亡率较低，30天死亡率为0.4%，1年死亡率为3.2%。接受膝上旁路移植术并使用GSV血管的间歇性跛行患者5年的原发性通畅率最高（对数秩检验P = 0.065）。无论远端旁路目标如何，使用GSV血管的患者5年无截肢生存率最高（对数秩检验P = 0.017）。多变量分析显示，年龄（HR 1.02 [1.00 - 1.04]，P = 0.023）和当前吸烟（HR 1.48 [1.06 - 2.06]，P = 0.021）被确定为原发性移植物通畅率降低的危险因素。无截肢生存的危险因素包括年龄（HR 1.03 [1.01 - 1.05]，P < 0.001）和GSV血管类型（HR 0.65 [0.46 - 0.90]，P = 0.011）。
间歇性跛行患者的股腘动脉旁路移植术与高伤口感染率和再次入院率相关。当前吸烟预示着该人群预后较差。这些数据可为血管内治疗时代间歇性跛行手术干预的临床决策提供参考。
