Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Department of Cardiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
PLoS One. 2022 Oct 27;17(10):e0275628. doi: 10.1371/journal.pone.0275628. eCollection 2022.
Femoro-popliteal bypass with autologous vascular graft is a key revascularization method in chronic limb-threatening ischemia (CLTI). However, the lack of suitable autologous conduit may occur in 15-45% of the patients, necessitating the implantation of prosthetic or allogen grafts. Only little data is available on the outcome of allograft use in CLTI.
Our objective were to evaluate the long term results of infrainguinal allograft bypass surgery in patients with chronic limb-threatening ischemia (CLTI) and compare the results of arterial and venous allografts.
Single center, retrospective study analysing the outcomes of infrainguinal allograft bypass surgery in patients with CLTI between January 2007 and December 2017.
During a 11-year period, 134 infrainguinal allograft bypasses were performed for CLTI [91 males (67.9%)]. Great saphenous vein (GSV) was implanted in 100 cases, superficial femoral artery (SFA) was implanted in 34 cases. Early postoperative complications appeared in 16.4% of cases and perioperative mortality (<30 days) was 1.4%. Primary patency at one, three and five years was 59%, 44% and 41%, respectively, while secondary patency was 60%, 45% and 41%, respectively. Primary patency of the SFA allografts was significantly higher than GSV allografts (1 year: SFA: 84% vs. GSV: 51% p = 0,001; 3 years: SFA: 76% vs. GSV: 32% p = 0,001; 5 years: SFA: 71% vs. GSV: 30% p = 0.001). Both primary and secondary patency of SFA allograft implanted in below-knee position were significantly higher than GSV bypasses (p = 0.0006; p = 0.0005, respectively). Limb salvage at one, three and five years following surgery was 74%, 64% and 62%, respectively. Long-term survival was 53% at 5 years.
Allograft implantation is a suitable method for limb salvage in CLTI. The patency of arterial allograft is better than venous allograft patency, especially in below-knee position during infrainguinal allograft bypass surgery.
股腘旁路移植自体血管移植物是慢性肢体威胁性缺血（CLTI）的关键再血管化方法。然而，15-45%的患者可能缺乏合适的自体移植物，需要植入假体或同种异体移植物。只有很少的数据可用于 CLTI 中同种异体移植物使用的结果。
我们的目的是评估慢性肢体威胁性缺血（CLTI）患者下肢旁路手术中同种异体移植物的长期结果，并比较动脉和静脉同种异体移植物的结果。
单中心回顾性研究分析了 2007 年 1 月至 2017 年 12 月期间 CLTI 患者下肢旁路手术的结果。
在 11 年期间，134 例慢性肢体威胁性缺血患者进行了下肢同种异体旁路手术[91 例男性（67.9%）]。大隐静脉（GSV）植入 100 例，股浅动脉（SFA）植入 34 例。术后早期并发症发生率为 16.4%，围手术期死亡率（<30 天）为 1.4%。1 年、3 年和 5 年的原发性通畅率分别为 59%、44%和 41%，继发性通畅率分别为 60%、45%和 41%。SFA 同种异体移植物的原发性通畅率明显高于 GSV 同种异体移植物（1 年：SFA：84%比 GSV：51%，p=0.001；3 年：SFA：76%比 GSV：32%，p=0.001；5 年：SFA：71%比 GSV：30%，p=0.001）。SFA 同种异体移植物植入膝关节以下的原发性和继发性通畅率明显高于 GSV 旁路移植术（p=0.0006；p=0.0005）。术后 1 年、3 年和 5 年的肢体存活率分别为 74%、64%和 62%。5 年时的长期生存率为 53%。
同种异体移植物植入是 CLTI 肢体挽救的一种合适方法。动脉同种异体移植物的通畅率优于静脉同种异体移植物，特别是在膝关节以下的下肢旁路手术中。
