Schneider J R, Besso S R, Walsh D B, Zwolak R M, Cronenwett J L
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon.
J Vasc Surg. 1994 Jan;19(1):43-55; discussion 55-7. doi: 10.1016/s0741-5214(94)70119-9.
Femorofemoral bypass (FFB) is used in selected patients when aortobifemoral bypass (AFB) is believed to be inappropriate because of high operative risk or predominantly unilateral iliac artery occlusive disease. We examined concurrent patients who underwent either FFB or AFB to better understand the appropriate use of FFB.
The characteristics and outcomes of patients who underwent FFB and AFB during 1986 to 1991 at our institution were retrospectively reviewed. Primary measures of outcome included patient survival, graft patency, limb salvage, and hemodynamic performance of FFB and AFB. Further analysis was performed after substratification for low versus high risk and claudication versus limb threat as the indication for surgery.
FFB was performed in older patients with more medical comorbidities when compared with AFB. Long-term graft patency was inferior after FFB compared with AFB (60% vs 85% at 3 years, p < 0.01). However, both FFB and AFB achieved limb salvage in more than 85% of patients at 3 years. When patients at low risk undergoing nonemergency AFB were compared with patients at low risk who underwent FFB and who had no contraindication to AFB, FFB proved inferior to AFB as measured by graft patency (primary patency 61% vs 87% at 3 years, p < 0.03) and hemodynamic performance (predicted ankle-brachial index with perfect outflow 0.82 after FFB vs 1.03 after AFB). On the basis of a detailed analysis of patient and graft risk factors, we could not explain the inferior patency rate of FFB, although our analysis suggested that inadequate inflow may contribute.
FFB is inferior to AFB as measured by patency and hemodynamic function. This inferior performance is independent of indications for FFB. AFB should remain the standard therapy for patients at low risk with iliac occlusive disease, but FFB provides adequate function and limb salvage in patients at high risk.
当因手术风险高或主要为单侧髂动脉闭塞性疾病而认为主动脉双股动脉旁路移植术（AFB）不适合时，股股动脉旁路移植术（FFB）用于特定患者。我们研究了接受FFB或AFB的同期患者，以更好地了解FFB的合理应用。
回顾性分析1986年至1991年在我院接受FFB和AFB的患者的特征和结局。主要结局指标包括患者生存率、移植物通畅率、肢体挽救情况以及FFB和AFB的血流动力学表现。在按低风险与高风险以及间歇性跛行与肢体威胁分层作为手术指征后进行了进一步分析。
与AFB相比，接受FFB的患者年龄更大，合并症更多。FFB术后的长期移植物通畅率低于AFB（3年时分别为60%和85%，p<0.01）。然而，FFB和AFB在3年时均使超过85%的患者肢体得以挽救。将低风险接受非急诊AFB的患者与低风险接受FFB且无AFB禁忌证的患者进行比较时，FFB在移植物通畅率（3年时原发性通畅率分别为61%和87%，p<0.03）和血流动力学表现（完美流出时预测的踝肱指数，FFB后为0.82，AFB后为1.03）方面均劣于AFB。基于对患者和移植物风险因素的详细分析，我们无法解释FFB较低的通畅率，尽管我们的分析表明流入不足可能有影响。
就通畅率和血流动力学功能而言，FFB劣于AFB。这种较差的表现与FFB的指征无关。AFB应仍然是低风险髂动脉闭塞性疾病患者的标准治疗方法，但FFB可为高风险患者提供足够的功能和肢体挽救。
