Robinson K D, Sato D T, Gregory R T, Gayle R G, DeMasi R J, Parent F N, Wheeler J R
Department of Surgery, Eastern Virginia Medical School, Norfolk, USA.
J Vasc Surg. 1997 Sep;26(3):425-37; discussion 437-8. doi: 10.1016/s0741-5214(97)70035-1.
To determine the long-term outcome and prognostic factors after early infrainguinal graft failure (< 30 days).
Retrospective analysis of limb salvage data, patency data, and prognostic risk factors in 112 new infrainguinal bypass grafts from 1985 to 1995 that occluded within 30 days of operation.
Thirty-six femoropopliteal and 76 femorotibial/femoropedal arterial bypass ("index") procedures were performed for rest pain (50%), tissue loss (31%), or disabling claudication (19%). In 103 patients, an immediate additional revascularization ("takeback") procedure was performed at the time of early graft failure. Life table analysis of the takeback procedures for threatened limbs (n = 84) revealed limb salvage rates of 74%, 54%, 40%, and 31% at 1 month, 1 year, 3 years, and 5 years, respectively. The 1-month limb salvage rate (threatened limbs) was 12% (1 of 8) in patients who were not taken back for revascularization and 33% (4 of 12) in patients who had undergone more than one takeback procedure within 30 days. The secondary graft patency rates for the takeback procedures (n = 103) were 70%, 37%, 27%, and 23% at 1 month, 1 year, 3 years, and 5 years, respectively. Univariate and life table analysis revealed that patients who were given anticoagulation medication after the index procedure (before graft thrombosis) or patients who had undergone previous ipsilateral leg revascularization had significantly lower rates of limb salvage and graft patency (p < 0.05). The limb salvage rate was also significantly worse in patients who had single-vessel runoff compared with those who had multiple-vessel runoff (p < 0.01). Thrombectomy and revision or complete graft replacement had a better secondary patency rate than thrombectomy alone (p < 0.05). Autogenous vein grafts had better outcome than polytetrafluoroethylene-containing grafts, but statistical significance was not achieved. No significant differences in limb salvage or graft patency rates were found between femoropopliteal versus femorotibial/femoropedal bypass grafting, age, gender, previous inflow surgery, diabetes, hypertension, smoking, or cardiac, renal, or pulmonary disease.
The long-term limb salvage and graft patency rates after takeback revascularization procedures for early graft failure are poor. Despite poor outcome, a single takeback procedure appears warranted in all patients. Multiple takeback procedures, however, do not appear to be justified, especially in patients who are given anticoagulation medication after the index bypass procedure, repeat leg bypass procedures, or if there is no potential for graft revision.
确定早期股腘以下移植物失败（<30天）后的长期结局及预后因素。
回顾性分析1985年至1995年间112例在术后30天内闭塞的新的股腘以下旁路移植术的保肢数据、通畅数据及预后危险因素。
进行了36例股腘动脉和76例股胫/股足动脉旁路（“索引”）手术，目的是缓解静息痛（50%）、组织缺损（31%）或重度间歇性跛行（19%）。103例患者在早期移植物失败时立即进行了再次血管重建（“补救”）手术。对有肢体威胁的患者（n = 84）的补救手术进行寿命表分析显示，1个月、1年、3年和5年时的保肢率分别为74%、54%、40%和31%。未进行再次血管重建补救的患者中，有肢体威胁者的1个月保肢率为12%（8例中的1例），而在30天内接受了不止一次补救手术的患者中为33%（12例中的4例）。补救手术（n = 103）的二次移植物通畅率在1个月、1年、3年和5年时分别为其70%、37%、27%和23%。单因素分析和寿命表分析显示，在索引手术（移植物血栓形成前）后接受抗凝药物治疗的患者或之前同侧下肢进行过血管重建的患者，保肢率和移植物通畅率显著较低（p < 0.05）。与有多支血管流出道的患者相比，单支血管流出道的患者保肢率也显著更差（p < 0.01）。血栓切除术联合移植物修复或完全置换的二次通畅率优于单纯血栓切除术（p < 0.05）。自体静脉移植物的结局优于含聚四氟乙烯的移植物，但未达到统计学显著性。股腘动脉旁路移植术与股胫/股足动脉旁路移植术、年龄、性别、既往流入道手术、糖尿病、高血压、吸烟或心脏、肾脏或肺部疾病之间，在保肢率或移植物通畅率方面未发现显著差异。
早期移植物失败后进行补救性血管重建手术后的长期保肢率和移植物通畅率较差。尽管结局不佳，但似乎所有患者都有必要进行单次补救手术。然而，多次补救手术似乎不合理，尤其是在索引旁路手术后接受抗凝药物治疗的患者、重复下肢旁路手术的患者或不存在移植物修复可能性的患者中。
