采用牛心包补片血管成形术行股总动脉血栓内膜切除术的临床结果

Clinical Outcomes of Common Femoral Thromboendarterectomy with Bovine Pericardium Patch Angioplasty.

作者信息

Okazaki Takanobu, Kobayashi Taira, Mochizuki Shingo, Ozawa Masamichi, Maeda Kazuki, Inoue Risa, Futagami Daisuke, Tachibana Hitoshi, Sato Katsutoshi, Hiraoka Toshifumi, Tomota Mayu, Emura Shogo, Shimizu Haruna, Takasaki Taiichi, Kodama Hiroshi, Takahashi Shinya

机构信息

Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima, Japan.

出版信息

Ann Vasc Surg. 2024 Jan;98:194-200. doi: 10.1016/j.avsg.2023.06.010. Epub 2023 Jun 28.

DOI:10.1016/j.avsg.2023.06.010

PMID:37385339

Abstract

BACKGROUND

The purpose of the study is to evaluate the efficacy of thromboendarterectomy (TEA) for common femoral occlusive disease using bovine pericardium patch angioplasty.

METHODS

The subjects were patients who underwent TEA for common femoral occlusive disease with bovine pericardium patch angioplasty from October 2020 to August 2021. The study had a prospective, multicenter, and observational design. The primary end point was primary patency (freedom from restenosis). The secondary end points were secondary patency, amputation-free survival (AFS), postoperative wound complication, hospital death within 30 days, and major adverse cardiovascular events (MACE) within 30 days.

RESULTS

Forty-seven TEA procedures with a bovine patch were performed in 42 patients (34 males; median age, 78 years; diabetes mellitus, 57%; end-stage renal disease with hemodialysis, 19%). Clinical presentations were intermittent claudication (68%) and critical limb-threatening ischemia (32%). Sixteen (34%) limbs underwent TEA alone and 31 (66%) underwent a combined procedure. Surgical site infection (SSI) occurred in 4 limbs (9%) and lymphatic fistulas in 3 limbs (6%). One limb with SSI required surgical debridement 19 days after the procedure, and 1 limb (2%) without postoperative wound complications required additional treatment due to acute bleeding. Hospital death within 30 days occurred in 1 case due to panperitonitis. There was no MACE within 30 days. Claudication was improved in all cases. Postoperative ABI of 0.92 [0.72-1.00] was significantly higher than the preoperative value (P < 0.001). The median follow-up period was 10 months [9-13 months]. One limb (2%) required additional endovascular therapy due to stenosis at the endarterectomy site at 5 months postoperatively. Primary and secondary patencies were 98% and 100% at 12 months, respectively, and the AFS rate was 90% at 12 months.

CONCLUSIONS

Common femoral TEA with bovine pericardium patch angioplasty has satisfactory clinical outcomes.

摘要

背景

本研究的目的是评估使用牛心包补片血管成形术治疗股总动脉闭塞性疾病的血栓内膜切除术（TEA）的疗效。

方法

研究对象为2020年10月至2021年8月期间接受牛心包补片血管成形术治疗股总动脉闭塞性疾病的患者。本研究采用前瞻性、多中心观察性设计。主要终点是原发性通畅率（无再狭窄）。次要终点包括继发性通畅率、无截肢生存率（AFS）、术后伤口并发症、30天内医院死亡以及30天内主要不良心血管事件（MACE）。

结果

42例患者（34例男性；中位年龄78岁；糖尿病患者占57%；接受血液透析的终末期肾病患者占19%）接受了47例采用牛心包补片的TEA手术。临床表现为间歇性跛行（68%）和严重肢体缺血（32%）。16例（34%）肢体仅接受了TEA手术，31例（66%）接受了联合手术。4例（9%）肢体发生手术部位感染（SSI），3例（6%）肢体发生淋巴瘘。1例发生SSI的肢体在术后19天需要手术清创，1例（2%）无术后伤口并发症的肢体因急性出血需要额外治疗。1例患者因弥漫性腹膜炎在30天内死亡。30天内无MACE发生。所有病例的跛行症状均得到改善。术后踝臂指数（ABI）为0.92[0.72 - 1.00]，显著高于术前值（P < 0.001）。中位随访期为10个月[9 - 13个月]。1例（2%）肢体在术后5个月因血栓内膜切除部位狭窄需要额外的血管内治疗。12个月时原发性和继发性通畅率分别为98%和100%，12个月时AFS率为90%。