Cavillon A, Melliere D, Allaire E, Blancas A E, Berrahal D, Desgranges P, Becquemin J P
Department of Vascular Surgery, Val de Marne University, Paris, France.
J Cardiovasc Surg (Torino). 1998 Jun;39(3):267-72.
This study was performed in order to determine if: 1-- femoral bypasses ending below the popliteal artery are justified in aged patients or in patients with poor general conditions, 2-- if the use of prosthetic material is justified when no vein is available, 3-- if reintervention is beneficial in case of bypass occlusion.
Retrospective study of 162 infrapopliteal bypasses followed during 1 to 12 years (mean: 1.5).
Vascular Surgery Department of the University Hospital Henri Mondor based in a suburb of Paris, France.
All patients who underwent a femoral bypass ending below the popliteal artery for limb salvage from January 1984 to December 1995.
These bypasses were performed with a vein in 131 cases and with a PTFE graft (with or without distal cuff) in 31 cases.
All patients were followed with clinical evaluation and duplex scan. Primary and secondary patency, limb salvage and patient survival were studied. The survival rates at 1 and 5 years were 87+/-3.8% and 66+/-9.6% respectively. Preoperative mortality was 7.4%. Renal insufficiency requiring dialysis, not age over 80, was associated with high perioperative mortality.
The primary patency rates of the total series at 1 and 5 years were 55 and 35% respectively for the total series. For venous bypasses, it was 58 and 37% while for prosthetic bypasses, it was 49 and 15%. The secondary patency rates at 1 and 5 years were 67 and 46% for the total series. For venous bypasses, it was 70 and 49% and for prosthetic bypasses, it was 53 and 21%. Limb salvage rates at 1 and 5 years were 65 and 61% for the total series, 73 and 65% for venous bypasses and 48 and 41% for prosthetic bypasses.
1-- Femorotibial or peroneal bypasses are worthwhile for limb salvage even in aged patients but renal insufficiency requiring dialysis may justify primary amputation. 2-- If no vein can be used, prosthetic or composite bypasses should be performed because they are associated with a 41% limb salvage rate at 5 years. 3-- If thrombosis occurs, the increase of patency after re-operation is 12% in case of venous bypass and 6% in case of prosthetic bypass.
本研究旨在确定：1. 对于老年患者或全身状况较差的患者，腘动脉以下的股动脉搭桥术是否合理；2. 在没有静脉可用时，使用人工材料是否合理；3. 在搭桥血管闭塞的情况下再次干预是否有益。
对162例腘动脉以下搭桥术进行回顾性研究，随访时间为1至12年（平均1.5年）。
法国巴黎郊区亨利·蒙多大学医院血管外科。
1984年1月至1995年12月期间，所有因肢体挽救而接受腘动脉以下股动脉搭桥术的患者。
131例搭桥术使用静脉，31例使用聚四氟乙烯移植物（带或不带远端袖套）。
所有患者均接受临床评估和双功超声扫描。研究一期和二期通畅率、肢体挽救率和患者生存率。1年和5年生存率分别为87±3.8%和66±9.6%。术前死亡率为7.4%。需要透析的肾功能不全，而非年龄超过80岁，与围手术期高死亡率相关。
整个系列的一期通畅率在1年和5年时分别为55%和35%。静脉搭桥术分别为58%和37%，人工血管搭桥术分别为49%和15%。整个系列的二期通畅率在1年和5年时分别为67%和46%。静脉搭桥术分别为70%和49%，人工血管搭桥术分别为53%和21%。整个系列的肢体挽救率在1年和5年时分别为65%和61%，静脉搭桥术分别为73%和65%，人工血管搭桥术分别为48%和41%。
