Kobayashi Taira, Hamamoto Masaki, Okazaki Takanobu, Tomota Mayu, Fujiwara Takashi, Yoshitomi Yuki, Hasegawa Misa, Takahashi Shinya
Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
J Vasc Surg. 2023 Jan;77(1):201-207. doi: 10.1016/j.jvs.2022.06.103. Epub 2022 Aug 4.
The Global Vascular Guidelines (GVGs) recommend initial revascularization (bypass or endovascular therapy) for chronic limb-threatening ischemia (CLTI) based on anatomical complexity and limb severity. This decision is made based on a prediction of the outcomes after endovascular intervention. This study was performed to evaluate outcomes after distal bypass in cases recommended for GVG bypass.
A total of 239 distal bypasses for CLTI were evaluated in 195 patients with a GVG bypass recommendation treated between 2009 and 2020 at a single center in Japan. Comparisons were made between crural and pedal bypass cases.
The 195 patients (median age, 77 years; 67% male) underwent 133 crural bypasses (106 patients; 54%) and 106 pedal bypasses (89 patients; 46%). Hemodialysis was more common in pedal cases than in crural cases (P = .03). Hospital deaths occurred in two cases (1%) within 30 days. The whole cohort has a follow-up rate of 96% over a mean of 28 ± 26 months, with 3-year limb salvage rates of 87% and 3-year primary, assisted primary, and secondary patency rates of 40%, 65%, and 67%, all without significant differences between crural and pedal cases. The 1-year wound healing rate was 88% and tended to be higher in crural cases than in pedal cases (P = .068). The 3-year survival rate was 52% in the cohort and did not differ significantly between crural and pedal cases.
Patients with CLTI with a GVG bypass recommendation had acceptable limb salvage, graft patency, wound healing, and survival after distal bypass, regardless of the bypass method. These findings indicate that a GVG bypass recommendation as an initial revascularization method is valid in the real world.
全球血管指南（GVGs）建议根据解剖复杂性和肢体严重程度，对慢性肢体威胁性缺血（CLTI）进行初始血运重建（旁路移植术或血管腔内治疗）。该决策基于对血管腔内干预后结局的预测。本研究旨在评估在被推荐进行GVG旁路移植术的病例中，远端旁路移植术后的结局。
对2009年至2020年期间在日本一家单一中心接受治疗的195例被推荐进行GVG旁路移植术的患者的239例CLTI远端旁路移植术进行了评估。对小腿旁路移植术和足部旁路移植术病例进行了比较。
195例患者（中位年龄77岁；67%为男性）接受了133例小腿旁路移植术（106例患者；54%）和106例足部旁路移植术（89例患者；46%）。足部病例中血液透析比小腿病例更常见（P = 0.03）。30天内发生医院死亡2例（1%）。整个队列的随访率为96%，平均随访28±26个月，3年肢体挽救率为87%，3年一期、辅助一期和二期通畅率分别为40%、65%和67%，小腿和足部病例之间均无显著差异。1年伤口愈合率为88%，小腿病例往往高于足部病例（P = 0.068）。队列的3年生存率为52%，小腿和足部病例之间无显著差异。
被推荐进行GVG旁路移植术的CLTI患者，无论采用何种旁路移植方法，在远端旁路移植术后均具有可接受的肢体挽救、移植物通畅、伤口愈合和生存率。这些发现表明，作为初始血运重建方法的GVG旁路移植术推荐在现实世界中是有效的。
