Woodburn K R, Rumley A, Lowe G D, Love J G, Murray G D, Pollock J G
Vascular Surgery Unit, Glasgow Royal Infirmary, Scotland, UK.
J Vasc Surg. 1996 Oct;24(4):639-46. doi: 10.1016/s0741-5214(96)70080-0.
The purpose of this study was to determine the effects of patient characteristics, blood rheology, and plasma biochemistry on the outcome of infrainguinal bypass grafting.
Blood rheology, plasma fibrinogen, cross-linked fibrin degradation products, von Willebrand factor (vWf) and other endothelial products, and clinical variables including smoking markers were determined before surgery in patients with 184 consecutive infrainguinal bypass grafts (90 vein, 94 synthetic grafts).
Fifty (27%) graft occlusions and 17 (9%) deaths occurred within 1 year of surgery. On univariate analysis a poor outcome was associated with elevated preoperative plasma fibrinogen, fibrin degradation products, vWf, and platelet levels, reduced hemoglobin and systolic ankle pressure, a below-knee anastomosis, a decrease in patent calf vessels, and the presence of tissue necrosis (all p < 0.001). On multivariate analysis increased preoperative vWf levels were predictive of poor postoperative outcome (relative hazard for upper quartile versus lower quartile = 1.82), as were a low systolic ankle pressure (relative hazard = 2.51), presence of tissue necrosis (relative hazard = 2.73), and female sex (relative hazard = 1.9). None of the other variables studied was related to outcome. With a preoperative risk score derived from the results, graft patency rates within 3 months of surgery fell to less than 25% with risk scores in the upper quartile.
Preoperative measurement of plasma vWf may enable more accurate prediction of the outcome of infrainguinal revascularization and when combined with other variables could assist in patient selection for these procedures. The association of vWf with graft occlusion supports a role for endothelial disturbance in graft occlusion.
本研究旨在确定患者特征、血液流变学和血浆生物化学对股腘动脉旁路移植术预后的影响。
对连续184例接受股腘动脉旁路移植术的患者（90例使用静脉移植物，94例使用人工合成移植物）在术前测定血液流变学、血浆纤维蛋白原、交联纤维蛋白降解产物、血管性血友病因子（vWf）及其他内皮产物，以及包括吸烟指标在内的临床变量。
术后1年内发生50例（27%）移植物闭塞和17例（9%）死亡。单因素分析显示，预后不良与术前血浆纤维蛋白原、纤维蛋白降解产物、vWf和血小板水平升高、血红蛋白和收缩期踝压降低、膝下吻合、小腿通畅血管减少以及组织坏死有关（均P<0.001）。多因素分析显示，术前vWf水平升高可预测术后预后不良（上四分位数与下四分位数相比的相对风险=1.82），收缩期踝压降低（相对风险=2.51）、组织坏死（相对风险=2.73）和女性（相对风险=1.9）也可预测。所研究的其他变量均与预后无关。根据结果得出术前风险评分，手术3个月内风险评分处于上四分位数时移植物通畅率降至25%以下。
术前测定血浆vWf可能有助于更准确地预测股腘动脉血运重建的预后，与其他变量结合可辅助这些手术的患者选择。vWf与移植物闭塞的关联支持内皮功能紊乱在移植物闭塞中的作用。
