Mohan C R, Hoballah J J, Martinasevic M, Schueppert M T, Sharp W J, Kresowik T F, Corson J D
Section of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Eur J Vasc Endovasc Surg. 1996 Feb;11(2):158-63. doi: 10.1016/s1078-5884(96)80045-1.
We analysed our results with the use of aortic polytetrafluoroethylene PTFE grafts over the last 7.5 years. A historical comparison was also made between the results with non-stretch PTFE (NS-PTFE) (1987-91) and stretch PTFE (S-PTFE) grafts (1991-94).
244 infrarenal aortic replacements or bypasses with PTFE grafts were performed at the University of Iowa Hospitals and Clinics from January 1987 to June 1994. Infrarenal aortic replacement was indicated for aortic aneurysmal disease in 192 patients (elective 151, symptomatic 20, ruptured 21) and bypass for aorto-iliac occlusive disease in 52 patients (disabling claudication 28, limb salvage 24). Patients ranged in age from 37 to 93 years (mean 68 years). There were 161 males and 83 females. Medical risk factors included hypertension (55%), coronary artery disease (31%), COPD (23%), diabetes mellitus (12%) chronic renal failure (9%), and smoking (61%). Aortic replacement or bypass was done with a NS-PTFE graft in 108 patients (44%) and a S-PTFE graft in 136 patients (56%). Postoperative ultrasound (US) scans and/or CT-studies were available in 40 patients with NS-PTFE and 26 patients with S-PTFE grafts.
The 30 day operative mortality was: elective AAA patients (1.3%), symptomatic AAA patients (10%), ruptured AAA patients (48%), limb salvage patients (4.1%) and disabling claudication patients (0%). Graft related complications included five graft limb thromboses (4 NS-PTFE, 1 S-PTFE). Two thromboses occurred perioperatively and the three others at 24, 28 and 30 months postoperatively. Two other graft related complications included a mixed pseudomonas and streptococcus groin infection with a culture negative perigraft fluid collection occurring 3 weeks following surgery (NS-PTFE), and distal aortic anastomotic suture line bleed on the first postoperative day following replacement of a ruptured AAA with a S-PTFE graft. Based on US and/or CT imaging studies, the mean internal diameters of the bodies of 40 NS-PTFE and 26 S-PTFE grafts were 11% and 10% greater than the manufacturer's specified sizes at a mean follow-up duration of 36 and 10 months respectively.
These data reveal that a PTFE graft performs satisfactorily in the aortic position with minimal adverse clinical sequence over a 7.5 year period. Continued long term follow up data will determine the ultimate suitability of aortic PTFE grafts.
我们分析了过去7.5年使用主动脉聚四氟乙烯（PTFE）移植物的结果。还对非拉伸PTFE（NS-PTFE，1987 - 1991年）和拉伸PTFE（S-PTFE）移植物（1991 - 1994年）的结果进行了历史比较。
1987年1月至1994年6月间，爱荷华大学医院及诊所进行了244例使用PTFE移植物的肾下腹主动脉置换或旁路手术。192例患者因主动脉瘤性疾病接受肾下腹主动脉置换（择期手术151例，有症状的20例，破裂的21例），52例患者因主-髂动脉闭塞性疾病接受旁路手术（致残性跛行28例，肢体挽救24例）。患者年龄在37岁至93岁之间（平均68岁）。男性161例，女性83例。医疗风险因素包括高血压（55%）、冠状动脉疾病（31%）、慢性阻塞性肺疾病（23%）、糖尿病（12%）、慢性肾衰竭（9%）和吸烟（61%）。108例患者（44%）使用NS-PTFE移植物进行主动脉置换或旁路手术，136例患者（56%）使用S-PTFE移植物。40例使用NS-PTFE移植物和26例使用S-PTFE移植物的患者术后有超声（US）扫描和/或CT检查结果。
30天手术死亡率为：择期腹主动脉瘤患者（1.3%）、有症状的腹主动脉瘤患者（10%）、破裂的腹主动脉瘤患者（48%）、肢体挽救患者（4.1%）和致残性跛行患者（0%）。移植物相关并发症包括5例移植物肢体血栓形成（4例NS-PTFE，1例S-PTFE）。2例血栓形成发生在围手术期，另外3例分别发生在术后24、28和30个月。另外2例移植物相关并发症包括1例术后3周发生的腹股沟混合性假单胞菌和链球菌感染，伴有移植周围液体培养阴性（NS-PTFE），以及1例用S-PTFE移植物置换破裂腹主动脉瘤后术后第1天发生的远端主动脉吻合口缝线处出血。根据US和/或CT影像学研究，40例NS-PTFE移植物和26例S-PTFE移植物主体的平均内径在平均随访36个月和10个月时分别比制造商规定尺寸大11%和10%。
这些数据表明，PTFE移植物在主动脉位置表现令人满意，在7.5年期间不良临床后果最小。持续的长期随访数据将确定主动脉PTFE移植物的最终适用性。
