Thompson Jamie, Li Renxi, Pomy Benjamin J, Ricotta John J, Sidawy Anton N, Lala Salim, Nguyen Bao-Ngoc
Department of Surgery, The George Washington University Hospital, Washington, DC.
The George Washington University School of Medicine and Health Sciences, Washington, DC.
Ann Vasc Surg. 2025 Jan;110(Pt A):82-90. doi: 10.1016/j.avsg.2024.07.118. Epub 2024 Sep 26.
Single-segment great saphenous vein (ssGSV) is the gold standard conduit for femoral-tibial bypasses in patients with critical limb-threatening ischemia (CLTI). In the absence of a good single-segment saphenous vein, alternative options are prosthetic grafts or spliced-vein (SpV) conduits. Although SpV conduits may provide better long-term patency/limb salvage, prosthetic grafts are more often the chosen conduit due to shorter operative and presumably better immediate postoperative outcomes; nevertheless, there are little data supporting this practice. In this study, we compared 30-day outcomes between SpV and prosthetic conduits in CLTI bypass using a national registry.
CLTI patients who underwent lower extremity bypass using SpV or prosthetic conduits only were selected from the National Surgical Quality Improvement Program targeted database. A 1:5 propensity score matching was conducted between SpV and prosthetic groups to address preoperative differences. Thirty-day outcomes, including primary patency, reintervention, major amputation, mortality, major morbidity, transfusion, and wound complications, were compared between the 2 groups.
There were 886 patients who underwent femoral-tibial bypass without ssGSV (104 SpV and 782 prosthetic grafts). All SpV patients were propensity score matched to 445 prosthetic patients. SpV exhibited significantly better 30-day primary patency than prosthetic (87.5% vs 74.38%, P = 0.004). SpV was associated with significantly longer operative time (346 min vs 222 min, P < 0.001) and higher transfusion (43.3% vs 27.87%, P = 0.003), but those did not translate into higher 30-day mortality or major systemic complications. There was no difference in wound complications or 30-day limb loss.
SpV conduit affords significantly better 30-day primary patency than prosthetic grafts without increased mortality and morbidities. Therefore, despite greater procedural complexity and longer operative time, SpV conduit should be considered when available. Future prospective studies are needed to investigate the long-term outcomes of these 2 conduits.
单段大隐静脉（ssGSV）是严重肢体缺血（CLTI）患者股-胫旁路移植术的金标准管道。若没有合适的单段大隐静脉，替代选择是人工血管或拼接静脉（SpV）管道。尽管SpV管道可能提供更好的长期通畅率/保肢效果，但由于手术时间较短且推测术后即刻效果更好，人工血管更常被选作管道；然而，几乎没有数据支持这种做法。在本研究中，我们使用全国登记数据库比较了CLTI旁路移植术中SpV和人工血管管道的30天结局。
从国家外科质量改进计划目标数据库中选取仅使用SpV或人工血管管道进行下肢旁路移植术的CLTI患者。在SpV组和人工血管组之间进行1:5倾向评分匹配，以解决术前差异。比较两组的30天结局，包括原发性通畅率、再次干预、大截肢、死亡率、严重并发症、输血和伤口并发症。
有886例患者在没有ssGSV的情况下接受了股-胫旁路移植术（104例使用SpV，782例使用人工血管）。所有SpV患者均与445例人工血管患者进行倾向评分匹配。SpV的30天原发性通畅率显著优于人工血管（87.5%对74.38%，P = 0.004）。SpV与显著更长的手术时间（346分钟对222分钟，P < 0.001）和更高的输血率（43.3%对27.87%，P = 0.003）相关，但这些并未转化为更高的30天死亡率或严重全身并发症。伤口并发症或30天肢体丢失方面没有差异。
SpV管道的30天原发性通畅率显著优于人工血管，且不增加死亡率和发病率。因此，尽管手术过程更复杂且手术时间更长，但如有SpV管道应予以考虑。未来需要进行前瞻性研究以调查这两种管道的长期结局。
