Pomposelli F B, Marcaccio E J, Gibbons G W, Campbell D R, Freeman D V, Burgess A M, Miller A, LoGerfo F W
Department of Surgery, New England Deaconess Hospital, Harvard Medical School, Boston.
J Vasc Surg. 1995 Mar;21(3):375-84. doi: 10.1016/s0741-5214(95)70279-2.
Although the technical feasibility of pedal artery bypass for limb salvage is now well established, questions remain about its most appropriate use and its long-term durability.
We reviewed our experience over an 8-year period in 367 consecutive patients undergoing 384 vein bypass grafts to the dorsalis pedis for limb salvage.
Ninety-five percent of the patients had diabetes mellitus. Infection complicated ischemia at initial presentation in 55.2% of patients. The preoperative arteriogram demonstrated a patent dorsalis pedis in 362 extremities (92.8%). Four hundred two patients underwent exploration for bypass, including 29 patients without demonstrated arteries on the arteriogram but audible pedal Doppler signals. Successful bypasses were carried out in 357 of 362 cases, where preoperative arteriography demonstrated a patent dorsalis pedis artery (98.6%), 16 of 28 cases explored on the basis of a Doppler signal alone (57%), and 11 of 12 patients where angiographic status was unknown. All procedures were performed with vein: in situ 38.5%, reversed 29%, nonreversed 18%, arm vein 7%, and composite vein 8%. Inflow was taken from the common femoral artery in 34%, superficial femoral or popliteal arteries in 60%, a previously placed graft in 5%, and a tibial artery in 1%. There were seven perioperative deaths (1.8%) and 21 myocardial infarctions (5.4%). Twenty-nine grafts failed within 30 days (7.5%), but 19 were successfully revised. Eight of the 10 failed grafts resulted in major amputation (80%). Over the remaining study period, there were 39 additional graft failures, of which 17 were successfully revised, and 17 additional major amputations. Actuarial primary and secondary patency and limb salvage rates were 68%, 82%, and 87%, respectively, at 5 years' followup. The actuarial patients survival rate was 57% at 5 years. Patency rates were similar for in situ and translocated saphenous vein grafts.
Dorsalis pedis arterial bypass is an effective limb salvage procedure with long-term durability comparable to distal vein grafts placed into more proximal arteries.
尽管足背动脉旁路移植术用于肢体挽救的技术可行性现已得到充分证实，但对于其最合适的应用方式及其长期耐用性仍存在疑问。
我们回顾了8年间连续367例患者接受384次静脉移植至足背动脉以挽救肢体的经验。
95%的患者患有糖尿病。55.2%的患者在初次就诊时感染并发缺血。术前动脉造影显示362条肢体（92.8%）的足背动脉通畅。402例患者接受了旁路移植探查，其中29例患者动脉造影未显示动脉，但足背多普勒信号可闻及。术前动脉造影显示足背动脉通畅的362例患者中有357例成功进行了旁路移植（98.6%），仅基于多普勒信号探查的28例患者中有16例成功（57%），血管造影情况未知的12例患者中有11例成功。所有手术均使用静脉：原位静脉38.5%，翻转静脉29%，未翻转静脉18%，手臂静脉7%，复合静脉8%。流入血管取自股总动脉的占34%，股浅动脉或腘动脉的占60%，先前置入的移植物的占5%，胫动脉的占1%。围手术期死亡7例（1.8%），心肌梗死21例（5.4%）。29条移植物在30天内失败（7.5%），但19条成功修复。10条失败移植物中有8条导致大截肢（80%）。在剩余的研究期间，又有39条移植物失败，其中17条成功修复，另有17例大截肢。5年随访时，初次通畅率、二次通畅率和肢体挽救率的精算值分别为68%、82%和87%。5年时患者精算生存率为57%。原位和移位大隐静脉移植物的通畅率相似。
足背动脉旁路移植术是一种有效的肢体挽救手术，其长期耐用性与置入更近端动脉的远端静脉移植物相当。
