Smith F C, Thomson I A, Hickey N C, Paterson I S, Tsang G M, Simms M H, Shearman C P
University Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, U.K.
Ann Vasc Surg. 1993 Jan;7(1):88-94. doi: 10.1007/BF02042665.
A prospective randomized placebo-controlled trial was conducted to determine the effects of the stable prostacyclin analogue iloprost on early graft patency and hemodynamic parameters during femorodistal reconstruction for critical leg ischemia. Peripheral resistance and graft blood flow were measured using an operative Doppler flowmeter and graft pressure transducer. Postoperative graft surveillance was continued at 1-month and then at 3-month intervals by duplex Doppler ultrasonography, measurement of ankle-brachial pressure indices, and intravenous digital subtraction angiography when indicated. In patients receiving 3000 ng of iloprost (n = 45) infused into the graft on completion there was an immediate mean decrease in peripheral resistance of 44% that persisted to skin closure in comparison with controls (n = 38) in whom no such decrease in resistance occurred (p < 0.001, Wilcoxon test). During the same period, mean graft blood flow increased in iloprost-treated patients by 74.5% compared with controls in whom there was a 6% increase in flow (p < 0.001). Primary cumulative patencies at 1 month were significantly higher in iloprost-treated grafts, 98% compared to 83% for controls (p < 0.05, log-rank test). Cumulative primary patencies at 1 year and secondary patencies at 1 month and 1 year were also greater in the iloprost-treated group (67%, 98%, and 87.6%, respectively) compared to controls (65%, 86%, and 79.3%, respectively), but these did not achieve statistical significance. A single bolus infusion of iloprost has prolonged beneficial effects on graft blood flow and peripheral resistance during femorodistal reconstruction. This is reflected by improved early primary graft patencies.(ABSTRACT TRUNCATED AT 250 WORDS)
开展了一项前瞻性随机安慰剂对照试验，以确定稳定的前列环素类似物伊洛前列素对严重下肢缺血行股-远端重建术时早期移植物通畅率及血流动力学参数的影响。使用术中多普勒流量计和移植物压力传感器测量外周阻力和移植物血流量。术后通过双功多普勒超声、踝肱压力指数测量以及必要时的静脉数字减影血管造影，在1个月时继续进行移植物监测，之后每3个月监测一次。在完成手术时接受3000 ng伊洛前列素注入移植物的患者（n = 45）中，外周阻力立即平均降低44%，直至皮肤缝合时仍持续存在，相比之下，对照组（n = 38）未出现此类阻力降低（Wilcoxon检验，p < 0.001）。在同一时期，伊洛前列素治疗的患者移植物平均血流量增加了74.5%，而对照组血流量增加了6%（p < 0.001）。伊洛前列素治疗的移植物1个月时的原发性累积通畅率显著更高，分别为98%和83%（对数秩检验，p < 0.05）。伊洛前列素治疗组1年时的原发性累积通畅率以及1个月和1年时的继发性通畅率也高于对照组（分别为67%、98%和87.6%）（对照组分别为65%、86%和79.3%），但这些差异未达到统计学显著性。在股-远端重建术中，单次推注伊洛前列素对移植物血流量和外周阻力具有持久的有益作用。这反映在早期原发性移植物通畅率的提高上。（摘要截短至250字）
