Long-Term Quality of Life and Mobility After Prosthetic Above-the-Knee Bypass Surgery
Long-Term Quality of Life and Mobility After Prosthetic Above-the-Knee Bypass Surgery
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DOI：
10.1016/j.avsg.2011.05.029
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发表时间：
2012-02-01
影响因子：
1.5
通讯作者：
Vahl, Anco C.
中科院分区：
文献类型：
--
作者：
Bosma, Jan;Turkcan, Kagan;Vahl, Anco C.
背景：已有多项研究涉及膝上股动脉旁路移植术；然而，有关晚期生活质量(QOL)和活动能力的信息很少。我们研究了膝关节以上搭桥手术后的长期生活质量和活动能力。方法：1997年12月至2003年1月，连续接受膝关节上人工血管搭桥术的患者出现跛行、缺血性静息痛或坏疽。使用的数据被记录在一个前瞻性收集的数据库中，该数据库记录了接受涤纶和聚四氟乙烯(PTFE)膝上搭桥术治疗下肢缺血的患者。主要结果是生活质量和活动能力，次要结果是通畅性和患者存活率。采用EuroQol问卷(EQ-5D/EQ-VAS)测量患者的生活质量。用行走障碍问卷(WIQ)评估患者的活动能力，并用单变量和多变量模型进行分析。结果：140例患者在研究期间接受了治疗。69名患者(50%)在随访期间死亡，留下71名幸存者(63名(89%)遵守要求)完成EQ-5D/EQ-VAS和WIQ问卷。主要预后参数(WIQ、EQ-5D、EQ-VAS)均不受直接搭桥闭塞(p=0.34、p=0.44、p=0.27)或长期通畅度(p=0.07、p=0.54、p=0.36)的影响。在所有主要结局参数中，男性显著地与较好的结局相关。接受涤纶和聚四氟乙烯植入者的WIQ分别为0.49和0.26(p=0.01)。涤纶和聚四氟乙烯患者的EQ-5D评分分别为0.576和0.409(P=0.08)，EQ-VAS评分分别为61和54(P=0.24)。移植物类型与闭塞无关，但径流与闭塞有关。5年和10年患者存活率分别为58%和51%。结论：在这项研究中，长期生活质量和机动性似乎与搭桥通畅无关，这是在一次晚期随访中评估的。翻修搭桥手术对长期生活质量和步行能力没有贡献。因此，在没有严重肢体缺血的情况下，在人工血管搭桥失败的情况下进行移植物监测和随后的翻修和/或血栓切除的必要性似乎是值得怀疑的。
Background: Multiple studies have addressed above-the-knee femoral artery bypass grafting; however, information on late quality of life (QoL) and mobility is scarce. We studied long-term QoL and mobility after above-the-knee bypass surgery.Methods: Consecutive patients presenting with claudication, ischemic rest pain, or gangrene who received above-the-knee prosthetic bypass grafting between December 1997 and January 2003 were included in this observational study. Data used were recorded in a prospectively collected database of patients receiving Dacron and polytetrafluoroethylene (PTFE) supragenicular bypasses for lower limb ischemia. Primary outcomes were QoL and mobility, and secondary outcomes were patency and patient survival. QoL was measured with the EuroQol questionnaire (EQ-5D/EQ-VAS). Mobility was assessed with the Walking Impairment Questionnaire (WIQ) and analyzed in univariate and multivariate models. Patency and survival were computed with Cox regression.Results: One hundred forty patients were treated during the study period. Sixty-nine patients (50%) died during follow-up, leaving 71 survivors who were asked (63 [89%] complied) to complete the EQ-5D/EQ-VAS and WIQ questionnaires. None of the primary outcome parameters (WIQ, EQ-5D, EQ-VAS) were affected by primary bypass occlusion (p = 0.34, p = 0.44, and p = 0.27, respectively) or long-term patency (p = 0.07, p = 0.54, and p = 0.36, respectively). Male sex was significantly associated with a better outcome on all primary outcome parameters. Patients with Dacron versus PTFE grafts had WIQ scores of 0.49 and 0.26, respectively (p = 0.01). EQ-5D scores of patients with Dacron and PTFE were 0.576 and 0.409 (p = 0.08) and EQ-VAS scores were 61 and 54, respectively (p = 0.24). Graft type was not independently associated with occlusion, but runoff was. The 5-year and 10-year patient survival rates were 58% and 51%, respectively.Conclusions: In this study, long-term QoL and mobility did not seem to be associated with bypass patency, as assessed in a single late follow-up. Revision of bypasses did not contribute to long-term QoL and walking ability. Therefore, the necessity of graft surveillance and subsequent revision and/or thrombectomy in case of synthetic bypass failure in absence of critical limb ischemia seems to be questionable.