Criado E, Burnham S J, Tinsley E A, Johnson G, Keagy B A
Department of Surgery, University of North Carolina at Chapel Hill School of Medicine 27599-7210.
J Vasc Surg. 1993 Sep;18(3):495-504; discussion 504-5.
To evaluate the results of femorofemoral bypass graft (FFBPG), we analyzed 110 consecutive FFBPGs performed at our institution during an 11-year period.
In 62 (56%) patients the indication for surgery was claudication and in 48 (44%) patients rest pain or tissue loss. In 42 patients the superficial femoral artery (SFA) was occluded. A preoperative percutaneous transluminal balloon angioplasty (PTA) was performed in 24 (22%) patients to correct a significant donor iliac artery stenosis. In 48 (44%) patients a total of 54 arterial procedures were performed simultaneously with FFBPG.
After surgery 75 (68%) patients were moderately or markedly improved, whereas 20 (18%) were minimally improved, unchanged, or worse, including 7 (6%) with hemodynamic failures. The in-hospital mortality rate was 4.5%. Actuarial patient survival rate was 70% +/- 8.6% at 6 years. The actuarial primary graft patency rate was 83% +/- 4.2% at 1 year, 71% +/- 6.9% at 3 years, 60% +/- 8.3% at 5 years, and 51% +/- 9.6% at 6 years. Age, sex, and race of the patient did not influence graft patency. Grafts placed for limb-threatening ischemia or in patients with SFA occlusion had a similar patency rate compared with those placed for claudication or in patients with patient SFA. The overall limb preservation rate was 83% +/- 7.3% at 5 years but was only 64% for patients who underwent operation for limb-threatening ischemia.
In conclusion, FFBPG offers moderately low long-term patency in a population with limited survival. Outflow procedures performed concomitantly with FFBPG seemed to compensate for the negative impact on graft patency rate of ipsilateral SFA occlusion and limb-threatening ischemia. Limb-threatening ischemia, however, carried a significantly higher (p < 0.05) amputation rate. The influence of preoperative donor iliac artery percutaneous transluminal balloon angioplasty on FFBPG patency remains unclear.
为评估股股旁路移植术（FFBPG）的效果，我们分析了本机构在11年期间连续进行的110例FFBPG。
62例（56%）患者的手术指征为间歇性跛行，48例（44%）患者为静息痛或组织缺损。42例患者的股浅动脉（SFA）闭塞。24例（22%）患者术前行经皮腔内球囊血管成形术（PTA）以纠正供体髂动脉明显狭窄。48例（44%）患者在进行FFBPG的同时共进行了54例动脉手术。
术后75例（68%）患者有中度或明显改善，而20例（18%）改善轻微、无变化或情况更糟，包括7例（6%）出现血流动力学衰竭。住院死亡率为4.5%。6年时患者的精算生存率为70%±8.6%。1年时移植血管的精算原发性通畅率为83%±4.2%，3年时为71%±6.9%，5年时为60%±8.3%，6年时为51%±9.6%。患者的年龄、性别和种族不影响移植血管通畅率。与因间歇性跛行或SFA通畅的患者相比，为肢体威胁性缺血患者或SFA闭塞患者进行的移植血管通畅率相似。5年时总体肢体保留率为83%±7.3%，但因肢体威胁性缺血接受手术的患者仅为64%。
总之，FFBPG在生存期有限的人群中提供了适度较低的长期通畅率。与FFBPG同时进行的流出道手术似乎弥补了同侧SFA闭塞和肢体威胁性缺血对移植血管通畅率的负面影响。然而，肢体威胁性缺血的截肢率显著更高（p<0.05）。术前供体髂动脉经皮腔内球囊血管成形术对FFBPG通畅率的影响仍不清楚。
