Eckstein H H, Schumacher H, Maeder N, Post S, Hupp T, Allenberg J R
Department of Surgery, Ruprecht-Karls University of Heidelberg, Germany.
Br J Surg. 1996 Nov;83(11):1554-7. doi: 10.1002/bjs.1800831120.
Fifty-six patients with limb-threatening ischaemia had pedal revascularization with either autologous vein (n = 39) or sequential composite graft with a 6-mm polytetrafluoroethylene prosthesis and autologous vein (n = 17); 75 per cent had gangrene and skin necrosis and 25 per cent had ischaemic rest pain alone. Twelve grafts occluded within the first week, and resulted in major amputation in eight patients after unsuccessful revision. Two patients required amputation for persistent ischaemia despite a patent bypass. One patient died from bowel perforation (2 per cent). In 47 (84 per cent) of the 56 patients limb and life were preserved. The primary patency rate after 1, 2 and 4 years was 65, 55 and 55 per cent respectively, the secondary patency rate was 71, 62 and 62 per cent, and cumulative limb salvage rates were 77, 71 and 66 per cent. Life-table survival rates during follow-up (median 25 (range 0-112) months) were 89, 78 and 52 per cent respectively after 1, 2 and 4 years. Thirteen of 21 patients who died during follow-up did not require major amputation. Pedal reconstruction with autologous vein provides limb salvage until death in nearly two-thirds of patients with critical limb ischaemia resulting from crural arterial occlusive disease.
56例患有肢体威胁性缺血的患者接受了足部血管重建术，其中39例采用自体静脉，17例采用6毫米聚四氟乙烯假体与自体静脉的序贯复合移植物；75%的患者有坏疽和皮肤坏死，25%的患者仅有缺血性静息痛。12条移植物在第一周内闭塞，8例患者在翻修失败后接受了大截肢。2例患者尽管旁路通畅，但因持续性缺血需要截肢。1例患者死于肠穿孔（2%）。56例患者中有47例（84%）肢体和生命得以保留。1年、2年和4年后的一期通畅率分别为65%、55%和55%，二期通畅率为71%、62%和62%，累积肢体挽救率为77%、71%和66%。随访期间（中位时间25个月（范围0 - 112个月））的生命表生存率在1年、2年和4年后分别为89%、78%和52%。随访期间死亡的21例患者中有13例不需要大截肢。对于因小腿动脉闭塞性疾病导致严重肢体缺血的患者，近三分之二采用自体静脉进行足部重建可在死亡前挽救肢体。
