Noronen Katariina, Söderström Maria, Kouhia Sanna, Venermo Maarit
Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland.
Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland.
J Vasc Surg. 2023 Jan;77(1):225-230. doi: 10.1016/j.jvs.2022.08.010. Epub 2022 Aug 18.
Bovine pericardial patch (BPP) is currently used in femoral angioplasty as an alternative for autologous vein patch (AVP), but studies comparing the results of the two methods are scarce. In this retrospective study, we aimed to discover the differences between BPP and AVP closure in long-term durability.
This study consisted of all femoral endarterectomies with BPP closure performed in Helsinki University Hospital from January 1, 2014, to December 31, 2017. For comparison, the same number of consecutive patients who underwent femoral endarterectomy with AVP closure from January 1, 2014, to October 16, 2016, were reviewed. Follow-up ended December 31, 2020. The mean follow-up was 19 months (range, 0-74 months) in the BPP group and 22 months (range, 0-79 months) in the AVP group. The primary endpoint was primary patency. Secondary endpoints were restenosis at patch site detected by imaging or perioperatively, patch rupture, and deep surgical wound infection. Propensity score analysis was performed for adjustment of differences between the AVP and BPP groups.
Overall primary patency was superior in the AVP group compared with the BPP group: at 1 year, 96.5% vs 85.0% and at 5 years, 83.0% vs 72.3% (P = .04). In propensity score-matched pairs (n = 92), no difference was found between the groups in primary patency: 95.7% and 95.7% at 1 year and 92.5% and 78.6% at 5 years (P = .861) or in freedom from restenosis: 100% and 100% at 1 year and 89.1% and 84.0% at 5 years (P = .057). Deep wound infections occurred slightly more often after BPP closure (8%) than after AVP closure (4%), but the difference was not statistically significant (P = .144). There were no patch ruptures in the BPP group, but in the AVP group, there were five ruptures (3.5%) (P = .024).
BPP is compatible to AVP in femoral endarterectomy in patency and can be regarded as the safer choice considering the risk of patch rupture.
牛心包补片（BPP）目前在股动脉血管成形术中用作自体静脉补片（AVP）的替代物，但比较这两种方法结果的研究较少。在这项回顾性研究中，我们旨在发现BPP和AVP闭合在长期耐久性方面的差异。
本研究纳入了2014年1月1日至2017年12月31日在赫尔辛基大学医院进行的所有采用BPP闭合的股动脉内膜切除术。为作比较，回顾了2014年1月1日至2016年10月16日连续接受AVP闭合股动脉内膜切除术的相同数量患者。随访于2020年12月31日结束。BPP组的平均随访时间为19个月（范围0 - 74个月），AVP组为22个月（范围0 - 79个月）。主要终点是原发性通畅率。次要终点是通过影像学或围手术期检测到的补片部位再狭窄、补片破裂和深部手术伤口感染。进行倾向评分分析以调整AVP组和BPP组之间的差异。
总体而言，AVP组的原发性通畅率优于BPP组：1年时分别为96.5%和85.0%，5年时分别为83.0%和72.3%（P = 0.04）。在倾向评分匹配对（n = 92）中，两组在原发性通畅率方面无差异：1年时分别为95.7%和95.7%，5年时分别为92.5%和78.6%（P = 0.861），在无再狭窄方面也无差异：1年时均为100%，5年时分别为89.1%和84.0%（P = 0.057）。BPP闭合后深部伤口感染的发生率略高于AVP闭合后（8%比4%），但差异无统计学意义（P = 0.144）。BPP组无补片破裂，但AVP组有5例破裂（3.5%）（P = 0.024）。
在股动脉内膜切除术中，BPP在通畅率方面与AVP相当，考虑到补片破裂的风险，可被视为更安全的选择。
