Prosthetic above-knee femoropopliteal bypass grafting: Five-year results of a randomized trial
Prosthetic above-knee femoropopliteal bypass grafting: Five-year results of a randomized trial
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DOI：
10.1016/s0741-5214(00)90300-8
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发表时间：
2000-03-01
影响因子：
4.3
通讯作者：
Garrett, HE
中科院分区：
文献类型：
--
作者：
Green, RM;Abbott, WM;Garrett, HE
目的：本试验旨在确定影响膝上股腘动脉旁路移植术 5 年通畅率的影响因素。方法：一项多机构前瞻性试验随机招募了 240 名患者，比较 Gore-tex 和 Hemashield 膝上股腘旁路移植术 5 年通畅率。使用 Kaplan-Meier 方法对每个预后变量水平之间的通畅性进行单变量比较。单变量 P 值小于 0.25 的变量或已知重要的变量被提交进行 Cox 回归分析。结果：患者 5 年生存率为 59.4%。两种移植材料之间的 5 年主要或次要通畅率没有差异（主要为 45% vs 43%，次要为 68% vs 68%）。对于年龄小于 65 岁的患者 (2.1; P = .001) 和直径小于 7 毫米的移植物 (1.65; P = .0219)，移植物闭塞的风险显着增加。对通畅率没有明显独立影响的变量包括吸烟状况、径流、糖尿病、性别、出现症状以及术后阿司匹林或香豆素治疗。无创测试结果不能预测随后的移植物功能。结论：虽然用于膝上股腘动脉旁路移植物的假体类型不会影响 5 年通畅率，但年龄和移植物尺寸确实会影响结果。在进行假体旁路移植手术之前应考虑这些因素。此外，这些数据应作为当代标准，可以将不断发展的程序与传统程序进行比较。
Purpose: This trial was designed to identify factors affecting patency rates of primary prosthetic above-knee femoropopliteal bypass grafts at 5 years.Methods: A multi-institutional, prospective trial randomized 240 patients to compare patency rates of Gore-tex and Hemashield above-knee femoropopliteal bypass grafts at 5 years. Univariate comparisons of patency between levels of each prognostic variable were made with the Kaplan-Meier method. Variables that had a univariate P value less than .25 or those known to be important were submitted to a Cox regression analysis.Results: The patient survival rate at 5 years was 59.4%. There were no differences in primary or secondary patency rates at 5 years between the two graft materials (primary, 45% vs 43% and secondary, 68% vs 68%). The risk for graft occlusion was significantly increased for patients younger than 65 years (2.1; P = .001) and for grafts with a diameter less than 7 mm (1.65; P = .0219). Variables with no apparent independent effect on patency rates were smoking status, runoff, diabetes mellitus, sex, presenting symptoms, and postoperative treatment with aspirin or Coumadin. Noninvasive test results were not predictive of subsequent graft function.Conclusion: Although the type of prosthetic used for above-knee femoropopliteal bypass grafts does not affect 5-year patency rates, age and graft size do influence results. These factors should be considered before a prosthetic bypass grafting procedure. Furthermore, these data should serve as a contemporary standard, with which evolving and conventional procedures can be compared.