Scott D J, Horrocks E H, Kinsella D, Horrocks M
Vascular Studies Unit, Bristol Royal Infirmary, U.K.
Eur J Vasc Surg. 1994 Jan;8(1):20-5. doi: 10.1016/s0950-821x(05)80114-8.
Calf vessel continuity with an intact pedal arch is an important factor in femorodistal (FD) bypass for critical ischaemia. Pulse generated runoff (PGR) was used in combination with the pedal arch patency test of Roedersheimer to determine preoperatively calf vessel and pedal arch patency. Three pedal arch groups were identified; complete (two calf vessels in continuity), incomplete (one vessel) and occluded (no vessels). One hundred non-reversed FD grafts were performed for critical ischaemia (63 men and 37 women), median age 72 (range 43-89 years). Sixteen grafts were to the above knee popliteal artery, 36 to the distal popliteal, three to the tibioperoneal trunk and 45 to a single calf vessel. There were 25 complete, 64 incomplete and 11 occluded pedal arches. The overall primary patency rate was 73%, nine grafts were successfully revised giving a secondary patency rate of 83.5%. The secondary graft patency rates for the above knee popliteal, below knee popliteal, tibioperoneal and single calf vessel grafts were 100, 92, 66 and 66% respectively. The 1 year graft patency rates for grafts to a complete, incomplete and occluded pedal arch were 88, 75 and 9% respectively (Lee-Desu p < 0.01). Similar results were obtained for limb salvage; 100, 84 and 24% respectively (p < 0.01). These results confirm the value of PGR in the preoperative assessment of patients with critical ischaemia. In reconstructions to the popliteal artery, PGR derived pedal arch status does not appear to influence the outcome. By contrast PGR derived pedal arch status in an excellent predictor of success following reconstructions to a single calf vessel.(ABSTRACT TRUNCATED AT 250 WORDS)
小腿血管连续性及完整的足弓是严重缺血性股腘（FD）旁路移植术的一个重要因素。脉冲血流（PGR）与Roedersheimer足弓通畅试验联合使用，以术前确定小腿血管和足弓的通畅情况。确定了三个足弓组：完整（两条小腿血管连续）、不完整（一条血管）和闭塞（无血管）。对严重缺血患者进行了100例非翻转FD移植术（63例男性和37例女性），中位年龄72岁（范围43 - 89岁）。16例移植至腘动脉膝上，36例至腘动脉远端，3例至胫腓干，45例至单条小腿血管。有25个完整足弓、64个不完整足弓和11个闭塞足弓。总体原发性通畅率为73%，9例移植成功翻修，继发性通畅率为83.5%。腘动脉膝上、腘动脉膝下、胫腓干和单条小腿血管移植的继发性移植通畅率分别为100%、92%、66%和66%。移植至完整、不完整和闭塞足弓的1年移植通畅率分别为88%、75%和9%（Lee-Desu p < 0.01）。保肢方面也得到了类似结果；分别为100%、84%和24%（p < 0.01）。这些结果证实了PGR在严重缺血患者术前评估中的价值。在腘动脉重建中，PGR得出的足弓状态似乎不影响结果。相比之下，PGR得出的足弓状态是单条小腿血管重建成功的良好预测指标。（摘要截短于250字）
