Strategies in the treatment of major tissue loss and gangrene: results of 100 consecutive vascular reconstructions.
Strategies in the treatment of major tissue loss and gangrene: results of 100 consecutive vascular reconstructions.
复制标题
主要组织损失和坏疽的治疗策略：100 次连续血管重建的结果。
DOI：
10.1007/bf02009450
复制
发表时间：
1990
影响因子：
1.5
通讯作者：
Sobel,M
中科院分区：
文献类型：
--
作者：
Reichman,W;Nichols,B;Toner,J;Jenvey,W;Sobel,M
To determine the features of a successful clinical strategy, we analyzed the results of 100 consecutive lower extremity vascular reconstructions performedexclusivelyfor tissue loss and gangrene of the legs and feet. Eighty patients underwent 100 procedures on 80 limbs. Follow-up was 95% complete (every six months, mean 2.2 years). Forty inflow procedures to the femoral artery were performed with 13 simultaneous infrainguinal bypasses. Sixty bypasses were performed from the femoral artery to the popliteal (25) or tibial arteries (35). Sixty-eight percent of the identified ulcerations healed, and limb salvage was achieved in 70% of patients by life-table analysis. The cumulative patency for all reconstructions was 48% (five years), for tibial bypasses 60% (four years). Femoropoliteal bypasses had the poorest patency and healing rates (<40%), while combined inflow-outflow procedures and femorotibial bypasses had the highest rates of healing (77%, 66%). There were two operative deaths, three graft infections, seven wound infections, and 12 acute graft thromboses. Vascular reconstructions for extensive tissue loss or gangrene can be performed with a morbidity and mortality comparable to procedures performed for less severe disease with a high rate of limb salvage. The long term success of surgical therapy depends primarily on the most direct revascularization of ischemic, infected tissues, using autologous conduits whenever possible.
