Does an adjuvant AV-fistula improve the patency of a femorocrural PTFE bypass with distal vein cuff in critical leg ischaemia?: A prospective randomised multicentre trial
Does an adjuvant AV-fistula improve the patency of a femorocrural PTFE bypass with distal vein cuff in critical leg ischaemia?: A prospective randomised multicentre trial
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DOI：
10.1016/j.ejvs.2003.12.003
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发表时间：
2004-02-01
影响因子：
5.7
通讯作者：
Lehtola, A
中科院分区：
文献类型：
--
作者：
Laurila, K;Lepäntalo, M;Lehtola, A
介绍。当试图对严重缺血的腿部进行血运重建时，缺乏合适的静脉会导致严重的问题。尽管使用远端吻合口袖口，假体移植物在股骨外侧位置的通畅程度要差得多。在远端吻合处使用辅助性房瘘可使移植物血流高于血栓阈值速度，从而增加假体移植物通畅。该研究的目的是评估辅助房室瘘对远端静脉袖带股农村聚四氟乙烯搭桥通畅的益处。材料和方法。这项前瞻性随机多中心试验在四个中心进行。共有59例严重腿部缺血且无合适静脉移植的患者被随机分配接受femocrural PTFE搭桥和远端静脉袖带；有或没有辅助的房室瘘。31例患者随机分为av -瘘管组（AVFG）和28例对照组（CG）。在2年的研究期间，6名患者没有随访。每个治疗组有6例即刻闭塞，但其中一半通过再次手术得以挽救。术后平均踝-臂指数（ABI）在AVFG组为0.85，在CG组为0.94。2年时，AVFG的原发性和继发性通畅率分别为29%和40%，CG （NS）的原发性和继发性通畅率分别为36%和40%。术后2年腿部恢复率分别为65%和68% （NS）。辅助房室瘘不能改善远端静脉袖带股农村聚四氟乙烯搭桥的通畅。
Introduction. A lack of suitable veins can cause serious problems when attempting to revascularise critically ischaemic legs. Prosthetic grafts have much worse patency in the femocrural position, despite the use of distal anastomotic cuffs. The use of adjuvant AV fistula at the distal anastomosis should increase the graft flow above the thrombotic threshold velocity and thus increase prosthetic graft patency.Aim. The aim of the study was to evaluate the benefit of an adjuvant AV fistula on the patency of a femorocrural PTFE bypass with a distal vein cuff.Materials and methods. This prospective randomised multicentre trial was conducted in four centres. A total of 59 patients with critical leg ischaemia and no suitable veins for grafting were randomised to receive a femocrural PTFE bypass and distal vein cuff; with or without an adjuvant AV fistula. Thirty-one patients were randomised to the AV-fistula group (AVFG) and 28 to the control group (CG). Six patients were lost to follow-up during the 2-year study time.Results. There were six immediate occlusions in each treatment group, but half of these were saved by re-operation. The mean postoperative ankle-bachial index (ABI) was 0.85 in the AVFG and 0.94 in the CG. The primary and secondary patency rate at 2 years was 29 and 40% for the AVFG and 36 and 40% for the CG (NS). Leg salvage at 2 years was 65 and 68%, respectively (NS).Conclusion. Adjuvant AV fistula does not improve the patency of a femorocrural PTFE bypass with a distal vein cuff.