Department of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Department of Surgery, Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Curr Cardiol Rep. 2024 Apr;26(4):211-220. doi: 10.1007/s11886-024-02027-4. Epub 2024 Feb 12.
The surgical management of symptomatic peripheral artery disease (PAD) has changed in the last few decades. Improvement in endovascular technology has resulted in more complex lesion once reserved for open surgery being addressed in an endovascular fashion. Even with these advances, there are lesions and patients that are better managed with an open surgical procedure. The aim of this review is to describe the most commonly performed open surgical procedures for PAD.
The recently published Best Endovascular versus Best Surgical Therapy (BEST-CLI) trial was an international, prospective, randomized controlled trial that aimed to investigate which revascularization (endovascular vs. surgical bypass) approach was superior for limb salvage. The evidence supports an open surgical bypass as an initial approach. The advancements made in the surgical management of PAD have provided options for patients who were once deemed poor surgical candidates. The goal continues to be utilization of the best available tools to address patient disease. In this current era, it is important to be familiar with the open surgical therapies.
过去几十年中，症状性外周动脉疾病（PAD）的外科治疗发生了变化。腔内技术的改进使曾经保留用于开放手术的更复杂病变得以通过腔内方式解决。即使有了这些进步，仍有一些病变和患者通过开放手术治疗效果更好。本文的目的是描述 PAD 最常进行的开放手术。
最近发表的最佳腔内治疗与最佳手术治疗（BEST-CLI）试验是一项国际、前瞻性、随机对照试验，旨在探讨哪种血运重建（腔内治疗与旁路手术）方法对肢体挽救更有效。证据支持开放旁路手术作为初始治疗方法。PAD 的外科治疗进展为曾经被认为是手术禁忌的患者提供了选择。目标仍然是利用最好的可用工具来解决患者的疾病。在当前这个时代，熟悉开放手术治疗非常重要。
