Pomposelli F B, Arora S, Gibbons G W, Frykberg R, Smakowski P, Campbell D R, Freeman D V, LoGerfo F W
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass, USA.
J Vasc Surg. 1998 Aug;28(2):215-25. doi: 10.1016/s0741-5214(98)70157-0.
The purpose of this study was to evaluate our results with lower extremity arterial reconstruction (LEAR) in patients 80 years of age or older and to assess its impact on ambulatory function and residential status.
We performed a retrospective review of all patients 80 years of age or older undergoing LEAR at a single institution from January 1990 through December 1995. Preoperative information regarding residential status and ambulatory function was obtained from the hospital record and vascular registry. Telephone interviews with patients or next of kin were undertaken to provide information regarding postoperative residential status and ambulatory function. Residential status and level of ambulatory function were graded by a simple scoring system in which 1 indicates living independently, walking without assistance; 2 indicate living at home with family, walking with an ambulatory assistance device; 3 indicates an extended stay in a rehabilitation facility, using a wheelchair; and 4 indicates permanent nursing home, bedridden. Preoperative and postoperative scores for both residential status and ambulatory function were compared. Kaplan-Meier survival curves were generated for graft patency, limb salvage, and patient survival.
Two hundred ninety-nine lower extremity bypass operations were performed in 262 patients 80 years of age or older (45% men, mean age 83.6 years, range 80 to 96 years). Sixty-seven percent of the patients had diabetes mellitus. Limb salvage was the indication for operation in 96%. The preoperative mean residential status and ambulatory function scores were 1.79+/-0.65 and 1.55+/-0.66, respectively. The perioperative mortality rate at 30 days was 2.3%. The median length of hospital stay decreased from 16 days in 1990 to 8 days in 1995 (range 4 to 145 days). Eighty-seven percent of grafts were performed with the autologous vein. The 5-year primary, assisted primary, and secondary graft patency rates for all grafts were 72%, 80%, and 87%, respectively. The limb salvage rate at 5 years was 92%. The patient survival rate at 5 years was 44%. The postoperative residential status and ambulatory function scores were 1.95+/-0.80 and 1.70+/-0.66, respectively. Overall scores remained the same or improved in 88% and 78% of patients, respectively.
LEAR in octogenarians is safe, with graft patency and limb salvage rates comparable to those reported for younger patients. LEAR preserves the ability to ambulate and reside at home for most patients.
本研究旨在评估我们对80岁及以上患者进行下肢动脉重建术（LEAR）的结果，并评估其对患者行走功能和居住状态的影响。
我们对1990年1月至1995年12月在单一机构接受LEAR的所有80岁及以上患者进行了回顾性研究。术前关于居住状态和行走功能的信息从医院记录和血管登记处获取。通过电话采访患者或其近亲以获取术后居住状态和行走功能的信息。居住状态和行走功能水平通过简单评分系统进行分级，其中1表示独立生活，无需协助行走；2表示与家人同住，借助行走辅助装置行走；3表示在康复机构长期停留，使用轮椅；4表示永久性疗养院，卧床不起。比较术前和术后居住状态及行走功能的评分。生成移植物通畅率、肢体挽救率和患者生存率的Kaplan-Meier生存曲线。
对262例80岁及以上患者进行了299例下肢搭桥手术（45%为男性，平均年龄83.6岁，范围80至96岁）。67%的患者患有糖尿病。96%的手术指征是肢体挽救。术前平均居住状态和行走功能评分分别为1.79±0.65和1.55±0.66。30天围手术期死亡率为2.3%。住院中位时间从1990年的16天降至1995年的8天（范围4至145天）。87%的移植物采用自体静脉。所有移植物的5年初级、辅助初级和次级移植物通畅率分别为72%、80%和87%。5年肢体挽救率为92%。5年患者生存率为44%。术后居住状态和行走功能评分分别为1.95±0.80和1.70±0.66。总体评分分别在88%和78%的患者中保持不变或有所改善。
对八旬老人进行LEAR是安全的，移植物通畅率和肢体挽救率与年轻患者报道的相当。LEAR能保留大多数患者的行走能力和居家居住能力。
