Sumner D S, Strandness D E
Surgery. 1978 Sep;84(3):348-55.
Despite revascularization of the common femoral--profunda femoris system, many patients fail to obtain satisfactory relief from claudication or rest pain. Clinical observations were compared with objective physiological data in 54 technically successful aortoiliofemoral reconstructions for multilevel disease. Nine of 28 operations (32%) for claudication and five of 26 operations (19%) for ischemia at rest had poor results. While the average ankle pressure index (API = ankle blood pressure/arm blood pressure) rose from 0.52 +/- 0.03 (SEM) to 0.81 +/- 0.03 in limbs treated successfully for claudication, it changed insignificantly in those with an unsuccessful result (0.58 +/- 0.04 to 0.61 +/- 0.04). When ischemic symptoms were relieved, API rose from 0.23 +/- 0.04 to 0.55 +/- 0.03 but increased only from 0.22 +/- 0.09 to 0.40 +/- 0.02 in limbs with insufficient improvement. Preoperative thigh pressure index (TPI) in claudicating limbs with poor results (0.96 +/- 0.05) differed little from that in limbs with good results (0.92 +/- 0.05); nor was the TPI of ischemic limbs with poor results (0.83 +/- 0.13) significantly greater than that in limbs with good results (0.60 +/- 0.05). Neither the TPI nor the thigh to ankle pressure gradient was of value in predicting which extremities would respond poorly to aortoiliofemoral reconstruction.
尽管股总动脉-股深动脉系统已实现血管重建，但许多患者的间歇性跛行或静息痛并未得到满意缓解。对54例技术成功的主动脉-髂股动脉重建术治疗多节段疾病的患者，将临床观察结果与客观生理数据进行了比较。28例治疗间歇性跛行的手术中有9例（32%）效果不佳，26例治疗静息缺血的手术中有5例（19%）效果不佳。对于成功治疗间歇性跛行的肢体，平均踝压指数（API = 踝部血压/臂部血压）从0.52±0.03（标准误）升至0.81±0.03，而效果不佳的肢体变化不显著（从0.58±0.04升至0.61±0.04）。当缺血症状得到缓解时，API从0.23±0.04升至0.55±0.03，但改善不足的肢体仅从0.22±0.09升至0.40±0.02。效果不佳的间歇性跛行肢体术前大腿压指数（TPI）（0.96±0.05）与效果良好的肢体（0.92±0.05）差异不大；效果不佳的缺血肢体的TPI（0.83±0.13）也未显著高于效果良好的肢体（0.60±0.05）。TPI和大腿至踝部的压力梯度在预测哪些肢体对主动脉-髂股动脉重建反应不佳方面均无价值。
