Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany.
Ann Vasc Surg. 2023 Aug;94:229-238. doi: 10.1016/j.avsg.2023.02.019. Epub 2023 Feb 28.
The acute occlusion of a peripheral bypass graft leads to acute limb ischemia (ALI) and threatens the viability of the limb if left untreated. The aim of the present study was to analyze the results of surgical and hybrid revascularization techniques for patients with ALI due to peripheral graft occlusions.
A retrospective analysis of 102 patients undergoing treatment for ALI due to peripheral graft occlusion between 2002 and 2021 was carried out at a tertiary vascular center. Procedures were classified as surgical when only surgical techniques were used and as hybrid when surgical procedures were combined with endovascular techniques such as balloon or stent angioplasty or thrombolysis. Endpoints were primary and secondary patency and amputation-free survival after 1 and 3 years.
Of all patients, 67 met the inclusion criteria, 41 were treated surgically and 26 by hybrid procedures. There were no significant differences in the 30-day patency rate, 30-day amputation rate, and 30-day mortality. The 1- and 3-year primary patency rates were 41.4% and 29.2% overall, respectively; 45% and 32.1% in the surgical group, respectively; and 33.2% and 26.6% in the hybrid group, respectively. The 1- and 3-year secondary patency rates were 54.1% and 35.8% overall, respectively; 52.5% and 34.2% in the surgical group, respectively; and 54.4% and 43.5% in the hybrid group, respectively. The 1- and 3-year amputation-free survival rates were 67.5% and 59.2%, overall, respectively; 67.3% and 67.3% in the surgical group, respectively; and 68.5% and 48.2% in the hybrid group, respectively. There were no significant differences between the surgical and the hybrid groups.
The results of surgical and hybrid procedures after bypass thrombectomy for ALI to eliminate the cause of infrainguinal bypass occlusion are comparable with good midterm results in terms of amputation-free survival. New endovascular techniques and devices need to be established in comparison to the results of these proven surgical revascularization methods.
外周旁路移植血管急性闭塞可导致急性肢体缺血（ALI），如果不及时治疗，会威胁肢体存活。本研究旨在分析外科和杂交血运重建技术治疗外周旁路移植血管闭塞引起的 ALI 患者的结果。
在一家三级血管中心对 2002 年至 2021 年间因外周旁路移植血管闭塞而接受 ALI 治疗的 102 例患者进行回顾性分析。仅使用外科技术的手术治疗，以及将外科手术与血管内技术（如球囊或支架血管成形术或溶栓术）相结合的杂交治疗。主要终点为术后 1 年和 3 年的通畅率和免于截肢的生存率，次要终点为术后 1 年和 3 年的通畅率。
所有患者中，67 例符合纳入标准，其中 41 例接受外科治疗，26 例接受杂交治疗。30 天通畅率、30 天截肢率和 30 天死亡率无显著差异。总体而言，1 年和 3 年的原发通畅率分别为 41.4%和 29.2%；外科组分别为 45%和 32.1%；杂交组分别为 33.2%和 26.6%。1 年和 3 年的继发通畅率分别为 54.1%和 35.8%；外科组分别为 52.5%和 34.2%；杂交组分别为 54.4%和 43.5%。1 年和 3 年的免于截肢生存率分别为 67.5%和 59.2%；外科组分别为 67.3%和 67.3%；杂交组分别为 68.5%和 48.2%。外科组和杂交组之间无显著差异。
旁路血栓切除术后治疗 ALI 以消除下肢旁路闭塞的病因，外科和杂交血运重建技术的结果可获得良好的中期免于截肢的生存率。与这些已证实的外科血运重建方法的结果相比，需要建立新的血管内技术和设备。
