降主动脉至股动脉旁路移植术

Descending thoracic aorta-to-femoral artery bypass grafts.

作者信息

Sapienza P, Mingoli A, Feldhaus R J, Napoli F, Marsan A, Franceschini M, di Marzo L, Cavallaro A

机构信息

Department of Surgery, Creighton University, Omaha, Nebraska, USA.

出版信息

Am J Surg. 1997 Dec;174(6):662-6. doi: 10.1016/s0002-9610(97)00184-0.

DOI:10.1016/s0002-9610(97)00184-0

PMID:9409593

Abstract

BACKGROUND

Descending thoracic aorta-to-femoral artery (DTAFA) bypass graft is an alternative procedure to revascularize lower limbs.

METHODS

Between 1976 and 1996, 41 patients underwent DTAFA bypass grafts. Operative indications consisted of previous abdominal graft thrombosis (22 cases, group 1), abdominal operations (8, group 2), initial vascular operation in the presence of difficult aortas (6, group 3), and infection of aortic grafts (5, group 4).

RESULTS

Perioperative mortality was 5%. Cumulative 10-year primary patency, limb salvage, and survival rates were 64%, 79%, and 55%, respectively. Breaking down the result on the basis of the four groups, DTAFA bypass grafts performed for infection of previous aortic grafts had a significantly lower primary patency rate (25% at 24 months; P < 0.004) with dismal limb salvage (31% at 24 months; P < 0.001) and survival rates (0% at 24 months; P < 0.005).

CONCLUSIONS

DTAFA bypass grafts can be safely and durably used in patients who had thrombosis of previous abdominal grafts or had a difficult abdomen or as the initial vascular operation in the presence of difficult aortas. Conversely, dismal results are obtained in the treatment of aortic graft infection.

摘要

背景

胸降主动脉至股动脉（DTAFA）旁路移植术是一种使下肢血管再通的替代手术。

方法

1976年至1996年间，41例患者接受了DTAFA旁路移植术。手术指征包括既往腹部移植血管血栓形成（22例，第1组）、腹部手术史（8例，第2组）、主动脉情况复杂时的初次血管手术（6例，第3组）以及主动脉移植血管感染（5例，第4组）。

结果

围手术期死亡率为5%。10年累积的一期通畅率、肢体挽救率和生存率分别为64%、79%和55%。根据四组情况分析结果，因既往主动脉移植血管感染而行DTAFA旁路移植术的一期通畅率显著较低（24个月时为25%；P<0.004），肢体挽救率令人沮丧（24个月时为31%；P<0.001），生存率也很低（24个月时为0%；P<0.005）。