Zakeryaev A B, Vinogradov R A, Sukhoruchkin P V, Butaev S R, Bakhishev T E, Urakov E R, Baryshev A G, Porkhanov V A
Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.
Kuban State Medical University, Krasnodar, Russia.
Khirurgiia (Mosk). 2022(10):44-50. doi: 10.17116/hirurgia202210144.
To analyze immediate and long-term results of various methods of femoropopliteal bypass grafting with autologous vein using propensity score matching.
A retrospective single-center open study included 464 patients who underwent femoropopliteal bypass grafting with an autologous vein between January 10, 2016 and December 25, 2019 at the Research Institute - Ochapovsky Regional Clinical Hospital No. 1. The following types of autovenous conduits were used: =266 - reversed autologous vein (group 1); =59 - autologous vein (group 2); =73 - upper limb autologous vein (group 3); =66 - autologous vein (group 4). The long-term period was 16.6±10.3 months.
We used propensity score matching analysis because patients were not comparable for some indicators. Groups 2-4 included small samples of patients, and their number was reduced to less than 10. This did not allow us to draw reliable conclusions about treatment outcomes. In this situation, we decided to allocate two groups: group 1 - femoropopliteal bypass grafting; group 2 - other variants of femoropopliteal bypass grafting with autologous vein. Propensity score matching allocated 299 people in group 1 and 46 patients in group 2. There were significant differences in early postoperative incidence of autologous vein thrombosis (group 1: =3 (6.5%), group 2: =79 (26.4%), =0.003; OR= 0.19; 95% CI 0.05-0.64) and postoperative wound suppuration (group 1: =2 (4.3%), group 2: =52 (17.4%); =0.02; OR=0.21; 95% CI 0.05-0.91). In long-term postoperative period, significant differences were obtained in the incidence of limb amputation (group 1: =6 (13%), group 2: =85 (28.4%); =0.02; OR=0.37; 95% CI 0.15-0.92) and myocardial infarction (group 1: =1 (2.2%), group 2: =43 (14.4%); =0.02; OR 0.13; 95% CI 0.01-0.98).
Femoropopliteal bypass grafting is characterized by lower incidence of graft thrombosis, amputations of the limb, mild decrease in the incidence of infectious complications and all adverse cardiovascular events in early and late postoperative period compared to conventional surgery (reversed autologous vein, autologous vein, upper limb autologous vein).
采用倾向评分匹配法分析自体静脉股腘动脉搭桥术不同方法的近期和远期效果。
一项回顾性单中心开放性研究纳入了2016年1月10日至2019年12月25日期间在奥恰波夫斯基第一地区临床医院研究所接受自体静脉股腘动脉搭桥术的464例患者。使用了以下几种自体静脉导管：=266例 - 自体静脉倒置（第1组）；=59例 - 自体静脉（第2组）；=73例 - 上肢自体静脉（第3组）；=66例 - 自体静脉（第4组）。长期随访时间为16.6±10.3个月。
由于患者在某些指标上不具有可比性，我们采用倾向评分匹配分析。第2 - 4组患者样本量较小，其数量减少至不足10例。这使我们无法就治疗结果得出可靠结论。在这种情况下，我们决定分为两组：第1组 - 股腘动脉搭桥术；第2组 - 自体静脉股腘动脉搭桥术的其他术式。倾向评分匹配法在第组分配了299人，第2组分配了46例患者。术后早期自体静脉血栓形成的发生率存在显著差异（第1组：=3例（6.5%），第2组：=79例（26.4%），=0.003；OR = 0.19；95% CI 0.05 - 0.64）以及术后伤口化脓情况（第1组：=2例（4.3%），第2组：=例（17.4%）；=0.02；OR = 0.21；95% CI 0.05 - 0.91）。在术后长期，肢体截肢发生率（第1组：=6例（13%），第2组：=85例（28.4%）；=0.02；OR = 0.37；95% CI 0.15 - 0.92）和心肌梗死发生率（第1组：=1例（2.2%），第2组：=43例（14.4%）；=0.02；OR 0.13；95% CI 0.01 - 0.98）存在显著差异。
与传统手术（自体静脉倒置、自体静脉、上肢自体静脉）相比，股腘动脉搭桥术的特点是移植物血栓形成、肢体截肢发生率较低，术后早期和晚期感染并发症及所有不良心血管事件的发生率轻度降低。
