高龄慢性肢体缺血患者的旁路血管选择。
Alternative vein bypass in octogenarians with chronic limb-threatening ischaemia.
机构信息
Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria.
Department of Medical Statistics, Paracelsus Medical University, Salzburg, Austria.
出版信息
BJS Open. 2024 May 8;8(3). doi: 10.1093/bjsopen/zrae041.
BACKGROUND
Octogenarians are regarded as one of the frailest patient groups among the chronic limb-threatening ischaemia population with high perioperative morbidity and mortality rates. As a result, alternative vein bypass surgery in the absence of sufficient great saphenous vein is often not considered as a potential treatment option. The aim of this study was to compare the results of octogenarians undergoing alternative vein bypass surgery due to chronic limb-threatening ischaemia to younger patients.
METHODS
A single-centre retrospective analysis of patients undergoing bypass surgery for chronic limb-threatening ischaemia with alternative autologous vein grafts between 1997 and 2018 was performed. Patients aged over 80 years were compared with those under 80 years. Graft patency rates were assessed and a risk factor analysis for limb loss was performed.
RESULTS
In total, 592 patients underwent bypass surgery during the study interval. Twenty-one per cent (n = 126) of patients were 80 years or older. At 4 years, primary, primary-assisted and secondary patency as well as limb salvage rates were not significantly different between the two groups (46% versus 50%, 60% versus 66%, 69% versus 72%, 72% versus 77%, for octogenarians versus non-octogenarians respectively). Major amputations were performed in 27 (21%) octogenarians and 91 (20%) non-octogenarians (P = 0.190). No higher 30-day and long-term mortality rates nor morbidity rates were detected in the octogenarian group with a median follow-up time of 27 (interquartile range 12-56) months. Minor amputation, the reason for alternative vein grafts, as well as the profunda femoris artery as proximal origin of the bypass were risk factors for limb loss in the postoperative course.
CONCLUSION
Alternative vein bypass surgery in octogenarians with chronic limb-threatening ischaemia is safe and effective in terms of patency rates, limb salvage and survival compared with younger patients in the absence of sufficient great saphenous vein. Age alone should not be a deterrent from performing bypass surgery.
背景
80 岁以上的老年人被认为是慢性肢体威胁性缺血人群中最脆弱的患者群体之一，他们的围手术期发病率和死亡率都很高。因此，在没有足够大隐静脉的情况下，替代静脉旁路手术通常不被视为潜在的治疗选择。本研究旨在比较因慢性肢体威胁性缺血而行替代静脉旁路手术的 80 岁以上老年人与年轻患者的结果。
方法
对 1997 年至 2018 年间因慢性肢体威胁性缺血行替代自体静脉移植旁路手术的患者进行了单中心回顾性分析。比较了 80 岁以上和 80 岁以下的患者。评估了移植物通畅率，并进行了肢体丧失的危险因素分析。
结果
在研究期间，共有 592 名患者接受了旁路手术。21%（n=126）的患者年龄在 80 岁或以上。4 年时，两组的主要通畅率、主要辅助通畅率、次要通畅率和肢体存活率无显著差异（80 岁以上组分别为 46%、60%、69%和 72%，80 岁以下组分别为 50%、66%、72%和 77%）。27 例（21%）80 岁以上患者和 91 例（20%）80 岁以下患者行大截肢术（P=0.190）。在中位随访时间为 27 个月（四分位距 12-56）的 80 岁以上组中，未发现更高的 30 天和长期死亡率或发病率。在术后，小截肢术、替代静脉移植物的原因以及旁路近端的股深动脉是肢体丧失的危险因素。
结论
在没有足够大隐静脉的情况下，与年轻患者相比，80 岁以上的慢性肢体威胁性缺血患者行替代静脉旁路手术在通畅率、肢体存活率和生存率方面是安全有效的。单纯的年龄不应成为进行旁路手术的障碍。
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