Eagleton M J, Illig K A, Green R M, Ouriel K, Riggs P N, DeWeese J A
Department of Surgery, University of Rochester Medical Center, NY 14642, USA.
J Vasc Surg. 1997 Dec;26(6):928-36; discussion 937-8. doi: 10.1016/s0741-5214(97)70004-1.
This study assessed whether multisegmental disease that is severe enough to require an inflow procedure adversely affects infrainguinal bypass patency, limb salvage, or patient survival rates.
The records of 495 patients who underwent 551 infrainguinal bypass grafting procedures were reviewed. Saphenous vein and prosthetic grafts were evaluated separately. Graft patency rates, patient limb salvage rates, and patient survival rates in those grafts that arose from a reconstructed inflow source were compared with those that arose from normal, nonreconstructed inflow sources. When grafts had either hemodynamic failure or occlusion, the cause of failure was identified.
Four-year primary patency rates in vein grafts that arose from a reconstructed inflow sources were lower than those in grafts that arose from nonreconstructed inflow sources (41% vs 54%; p = 0.006). Assisted primary patency rates and secondary patency rates, however, were similar (62% vs 74% and 64% vs 77%, respectively). The 4-year primary patency rate (45% vs 55%), assisted primary patency rate (60% vs 60%), and secondary patency rate (60% vs 61%) in prosthetic grafts did not vary based on inflow source. The most common cause of graft failure was inflow failure, except in the vein grafts that did not require an inflow procedure, in which the most common cause of failure was graft failure. Inflow failure occurred in 24% and 22% of the vein and prosthetic grafts with multisegmental disease, respectively, but in only 7% (p < 0.001) and 10% (p < 0.05), respectively, of those that arose from normal nonreconstructed inflow. The presence of an inflow procedure did not affect limb salvage rates or patient survival rates, regardless of graft material.
Long-term patency rates, patient limb salvage rates, and survival rates in patients with a reconstructed inflow source were similar to those of patients with a normal nonreconstructed inflow. A major cause of occlusion is inflow failure, and this occurs in a greater proportion of patients with multisegmental disease. These patients, in particular, may benefit from patient surveillance to screen for progression of their inflow disease and to allow for intervention before infrainguinal graft occlusion.
本研究评估了严重到需要进行流入道手术的多节段疾病是否会对股腘动脉旁路移植术的通畅率、肢体挽救率或患者生存率产生不利影响。
回顾了495例行551次股腘动脉旁路移植术患者的记录。分别对大隐静脉移植物和人工血管移植物进行评估。将来自重建流入道来源的移植物的通畅率、患者肢体挽救率和患者生存率与来自正常、未重建流入道来源的移植物进行比较。当移植物出现血流动力学衰竭或闭塞时，确定失败原因。
来自重建流入道来源的静脉移植物的4年原发性通畅率低于来自未重建流入道来源的移植物（41%对54%；p = 0.006）。然而，辅助原发性通畅率和继发性通畅率相似（分别为62%对74%和64%对77%）。人工血管移植物的4年原发性通畅率（45%对55%）、辅助原发性通畅率（60%对60%）和继发性通畅率（60%对61%）不受流入道来源的影响。移植物失败的最常见原因是流入道失败，但在不需要流入道手术的静脉移植物中，最常见的失败原因是移植物本身失败。多节段疾病的静脉移植物和人工血管移植物中分别有24%和22%发生流入道失败，但来自正常未重建流入道的移植物中分别仅为7%（p < 0.001）和10%（p < 0.05）。无论移植物材料如何，流入道手术的存在均不影响肢体挽救率或患者生存率。
重建流入道来源的患者的长期通畅率、患者肢体挽救率和生存率与正常未重建流入道的患者相似。闭塞的主要原因是流入道失败，且在多节段疾病患者中发生率更高。这些患者尤其可能受益于患者监测，以筛查其流入道疾病的进展，并在股腘动脉移植物闭塞前进行干预。
