Magnant J G, Cronenwett J L, Walsh D B, Schneider J R, Besso S R, Zwolak R M
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.
J Vasc Surg. 1993 Jan;17(1):67-76; discussion 76-8.
This study reviewed the outcome of 131 women who underwent infrainguinal bypass in 150 limbs from 1984 to 1991 for limb-threatening ischemia (95%) or disabling claudication (5%).
These women were compared with 209 men who underwent infrainguinal arterial reconstruction of 231 lower extremities for limb threat (89%) or claudication (11%) during the same interval. On average, women were 3 years older than men (mean age 72 vs 69 years, p < 0.005) but were less frequently cigarette smokers (56% women, 68% men, p < 0.05). Fifty-two percent of women had diabetes and 67% had hypertension, similar to the male patients. Infrainguinal disease distribution necessitated bypass to the above-knee popliteal artery in 10%, to the below-knee popliteal artery in 25%, and to the tibial or pedal arteries in 65% of women, comparable to the disease distribution in men. Autogenous vein grafts were performed in 90% of both groups.
Early postoperative (30-day) mortality was 4% for women and 2% for men (not significant). Life-table survival after 3 years, however, was only 54% in women, compared with 72% in men (p < 0.05). Multivariate analysis indicated that diabetes increased the mortality rate 2.5-fold in women, which was not true in men. Three-year life-table survival of women with diabetes was only 39%, compared with 78% in women without diabetes (p < 0.001). Primary graft patency in women was 59% at 1 year and 54% at 3 years, significantly less than the 73% and 70% graft patency rates observed in men (p < 0.005). Secondary graft patency improved in women to 75% and 69% after 1 and 3 years, but this was still significantly less than the secondary patency rates of 89% and 86% observed in men (p < 0.001). Multivariate analysis indicated that female sex decreased secondary graft patency 2.4-fold and was the only variable associated with graft failure. Cumulative 3-year limb salvage in women was 82%, not statistically different than the 89% limb salvage rate observed in men.
Women and men requiring arterial reconstruction for infrainguinal occlusive disease had comparable operative mortality and limb salvage rates, but long-term survival and graft patency were significantly reduced in women. Our results indicate that sex substantially influences the outcome of patients after infrainguinal bypass.
本研究回顾了1984年至1991年间131名女性患者的150条下肢接受股下旁路手术的结果，这些患者因肢体威胁性缺血（95%）或致残性间歇性跛行（5%）而接受手术。
将这些女性患者与同期209名男性患者进行比较，后者因肢体威胁（89%）或间歇性跛行（11%）接受了231条下肢的股下动脉重建手术。平均而言，女性比男性大3岁（平均年龄72岁对69岁，p<0.005），但女性吸烟的比例较低（女性为56%，男性为68%，p<0.05）。52%的女性患有糖尿病，67%的女性患有高血压，与男性患者相似。在女性中，股下疾病分布需要旁路至膝上腘动脉的占10%，至膝下腘动脉的占25%，至胫动脉或足背动脉的占65%，与男性的疾病分布相当。两组均有90%进行了自体静脉移植。
术后早期（30天）死亡率女性为4%，男性为2%（无显著差异）。然而，3年后的生命表生存情况显示，女性仅为54%，而男性为72%（p<0.05）。多变量分析表明，糖尿病使女性的死亡率增加2.5倍，而男性并非如此。患有糖尿病的女性3年生命表生存率仅为39%，而无糖尿病的女性为78%（p<0.001）。女性的一期移植物通畅率在1年时为59%，3年时为54%，显著低于男性观察到的73%和70%的移植物通畅率（p<0.005）。女性的二期移植物通畅率在1年和3年后分别提高到75%和69%，但仍显著低于男性观察到的89%和86%的二期通畅率（p<0.001）。多变量分析表明，女性性别使二期移植物通畅率降低2.4倍，且是与移植物失败相关的唯一变量。女性3年累计肢体挽救率为82%，与男性观察到的89%的肢体挽救率无统计学差异。
因股下闭塞性疾病需要进行动脉重建的女性和男性手术死亡率和肢体挽救率相当，但女性的长期生存率和移植物通畅率显著降低。我们的结果表明，性别对股下旁路术后患者的预后有重大影响。
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