Rutledge R, Burnham S J
J Cardiovasc Surg (Torino). 1983 Mar-Apr;24(2):107-10.
107 patients underwent vascular reconstruction for ischemic peripheral vascular disease distal to the inguinal ligament at the North Carolina Memorial Hospital from 1973 to 1979. All patients were evaluated with pre-operative Doppler arterial pressures and arteriography. 93 underwent femoral bypass grafting. 14 patients who were not felt to be candidates for bypass and were selected for primary profundaplasty form the subject of this report. Patients presented with a chief complaint of claudication, acute onset of rest pain secondary to acute occlusion or gangrene. Ankle/brachial ratio was as follows: Claudication, 0.56; chronic rest pain, 0.29; gangrene, 0.43, acute occlusion, 0.36. Outcome by patient group showed that both patients who presented with acute onset of rest pain had successful outcomes; 1 success and 2 patients with no change in symptoms in the group who presented with claudication; all patients with gangrene failed to improve and underwent major amputation. The best preoperative predictor was the patient's presenting complaint. Neither Doppler arterial pressures, the presence of diabetes nor arteriography were helpful in selecting patients for favorable outcomes. In our experience, few patients with severe peripheral vascular disease distal to the inguinal ligament unreconstructible by other means will benefit from primary profundaplasty. A possible exception are patients who present with acute arterial occlusion.
1973年至1979年期间，107例患者在北卡罗来纳州纪念医院接受了腹股沟韧带远端缺血性周围血管疾病的血管重建手术。所有患者均接受了术前多普勒动脉压和动脉造影评估。93例患者接受了股动脉旁路移植术。14例被认为不适合进行旁路手术而被选择进行初次股深动脉成形术的患者构成了本报告的研究对象。患者的主要症状为间歇性跛行、急性闭塞后继发的静息痛急性发作或坏疽。踝/臂指数如下：间歇性跛行为0.56；慢性静息痛为0.29；坏疽为0.43；急性闭塞为0.36。按患者组别的结果显示，出现静息痛急性发作的患者均取得了成功的治疗效果；间歇性跛行组中有1例成功，2例症状无变化；所有坏疽患者均未改善并接受了大截肢手术。术前最佳预测指标是患者的主要症状。多普勒动脉压、糖尿病的存在以及动脉造影在选择预后良好的患者方面均无帮助。根据我们的经验，很少有腹股沟韧带远端严重周围血管疾病且无法通过其他方法重建的患者能从初次股深动脉成形术中获益。一个可能的例外是出现急性动脉闭塞的患者。
