van der Heijden F H, Eikelboom B C, van Reedt Dortland R W, van der Graaf Y, Steijling J J, Legemate D A, Theodorides T, van Vroonhoven T J
Department of Surgery, University Hospital Utrecht, The Netherlands.
J Vasc Surg. 1993 Aug;18(2):271-9.
The optimal method of treatment of superficial femoral artery occlusive disease has yet to be established. Therapeutic options include percutaneous transluminal angioplasty for short lesions and reversed or in situ autologous saphenous vein bypass for long lesions. Currently, staged revascularization with polytetrafluoroethylene as an initial conduit and autologous vein for secondary procedures is suggested. An alternative to these procedures is endarterectomy of the occluded superficial femoral artery, followed by a femoropopliteal bypass in cases of endarterectomy failure. Our results with this procedure are reviewed in this article.
From 1980 until 1990, 259 endarterectomies of the superficial femoral artery were attempted, 231 of which were successfully performed in 197 patients (145 men and 52 women), with an average age of 64 years (range 40 to 82 years). The indication for successfully performed endarterectomy was claudication in 186 patients (80%), rest pain in 21 (9%), and gangrene in 24 (11%). The postoperative mortality rate was 0.8% with a complication rate of 10%.
Eighty-two failures occurred during follow-up, of which 33 were treated with peripheral bypass. Five additional bypasses were performed because of occlusions distal from the endarterectomized segment. The 5-year primary overall patency rate of successfully performed endarterectomy was 71% (SE 3.6). The 5-year overall secondary bypass patency rate was 61% (SE 11.3). The combined endarterectomy and bypass patency rate (tertiary patency) was 79% (SE 3.3) after 5 years and 45% (SE 7.6) after 10 years. The overall amputation rate was 5.6% and the amputation rate was 1.6% in patients treated for claudication.
The combination of endarterectomy and peripheral bypass provides a valuable alternative to the current treatment of superficial femoral artery occlusive disease.
股浅动脉闭塞性疾病的最佳治疗方法尚未确定。治疗选择包括对短病变进行经皮腔内血管成形术，对长病变进行自体大隐静脉逆行或原位搭桥术。目前，建议采用分期血管重建术，初始阶段使用聚四氟乙烯作为管道，二期手术使用自体静脉。这些手术的一种替代方法是对闭塞的股浅动脉进行内膜切除术，如果内膜切除术失败，则进行股腘动脉搭桥术。本文回顾了我们采用该手术的结果。
1980年至1990年期间，尝试对股浅动脉进行259例内膜切除术，其中231例在197例患者（145例男性和52例女性）中成功实施，平均年龄64岁（范围40至82岁）。成功实施内膜切除术的指征为186例患者（80%）出现间歇性跛行，21例（9%）出现静息痛，24例（11%）出现坏疽。术后死亡率为0.8%，并发症发生率为10%。
随访期间发生82例失败，其中33例接受了外周搭桥术。另外5例搭桥术是因为内膜切除段远端出现闭塞而进行的。成功实施内膜切除术的5年原发性总体通畅率为71%（标准误3.6）。5年总体二次搭桥通畅率为61%（标准误11.3）。内膜切除术和搭桥术联合通畅率（三次通畅率）5年后为79%（标准误3.3），10年后为45%（标准误7.6）。总体截肢率为5.6%，接受间歇性跛行治疗的患者截肢率为1.6%。
内膜切除术和外周搭桥术的联合为当前股浅动脉闭塞性疾病的治疗提供了一种有价值的替代方法。
