Klamer T W, George S M, Lambert G E
Department of Surgery, University of Louisville, KY.
J Ky Med Assoc. 1996 Jul;94(7):270-7.
Revascularization is the only alternative to amputation for patients with severe, symptomatic infrainguinal ischemia. It is the purpose of this study to determine the success of revascularization as defined by limb salvage in a personal 10-year operative experience.
Primary infrainguinal bypass procedures were performed on 312 threatened limbs of 271 consecutive patients in the period between January 1, 1983, and December 31, 1992. Repeat revascularization was performed for failing/failed grafts as long as the extremity was viable and an outflow vessel could be found by either preoperative or intraoperative angiography.
Ten patients died within 30 days of the primary procedure (4%) and the 5-year patient survival was 57%. Major amputations (AK or BK) were performed on 50 extremities over the 10-year period; cumulative 72-month limb salvage was 72%. Fifty-eight of the 312 extremities (19%) required 81 reoperations for failing/failed grafts, including a second procedure in 58, a third procedure in 14, and a fourth procedure in 9. Graft occlusions in which revision was either not attempted or was ultimately unsuccessful occurred in 72 extremities and led to 44 amputations. Cumulative primary and secondary graft patency for autologous conduit was clearly superior to nonautologous conduit (57% and 67% vs 20% and 21% respectively at 60 months).
We believe that this approach to infrainguinal revascularization is warranted as the mortality is low and the likelihood of success is high. A long term commitment to careful postoperative surveillance is mandatory as reintervention is frequently required to maintain graft patency and limb salvage.
对于患有严重症状性股腘动脉缺血的患者，血管重建术是截肢的唯一替代方法。本研究的目的是根据个人10年的手术经验，确定以保肢定义的血管重建术的成功率。
1983年1月1日至1992年12月31日期间，对271例连续患者的312条濒危肢体进行了原发性股腘动脉搭桥手术。只要肢体仍有存活能力且术前或术中血管造影能找到流出道血管，对于失败/失效的移植物就进行再次血管重建术。
10例患者在初次手术后30天内死亡（4%），5年患者生存率为57%。在这10年期间，对50条肢体进行了大截肢（膝上或膝下截肢）；72个月的累积保肢率为72%。312条肢体中有58条（19%）因移植物失败/失效需要进行81次再次手术，其中第二次手术58例，第三次手术14例，第四次手术9例。72条肢体发生了未尝试修复或最终修复未成功的移植物闭塞，导致44例截肢。自体血管移植物的累积原发性和继发性通畅率明显优于非自体血管移植物（60个月时分别为57%和67%，对比20%和21%）。
我们认为这种股腘动脉血管重建方法是合理的，因为死亡率低且成功率高。由于经常需要再次干预以维持移植物通畅和保肢，因此必须长期致力于术后仔细监测。
