Polytetrafluoroethylene bypasses to infrapopliteal arteries without cuffs or patches: A better option than amputation in patients without autologous vein
Polytetrafluoroethylene bypasses to infrapopliteal arteries without cuffs or patches: A better option than amputation in patients without autologous vein
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DOI：
10.1016/s0741-5214(96)70280-x
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发表时间：
1996-02-01
影响因子：
4.3
通讯作者：
Schwartz, ML
中科院分区：
文献类型：
--
作者：
Parsons, RE;Suggs, WD;Schwartz, ML
目的：评价聚四氟乙烯(PTFE)胫腓动脉搭桥术在保肢手术中的应用效果。方法：1986年1月至1995年5月，在我科施行腹股沟下保肢手术的63例患者中，63例患者立即截肢，双重检查和手术探查时无自体静脉，仅有一条胫骨或腓动脉作为分流血管。大多数患者(82%)有两次或两次以上同侧腹股沟下搭桥手术。这63例患者接受了66例胫骨或腓动脉的PTFE搭桥术，没有远端吻合静脉袖带或附着性动静脉瘘。然后将我们的结果与报道的采用替代的自体静脉来源或PTFE结合各种推荐辅助装置进行的腓下(脚)旁路手术进行比较。结果：我们的PTFE静脉旁路术后3年和5年的累积移植物通畅率分别为39%+/-7%和28%+/-9%。术后3年和5年的移植血管二次通畅率分别为55%+/-8%和43%+/-10%。肢体保留率3年为71%+/-7%，5年为66%+/-8%。两年的精算患者存活率仅为67%+/-7%。结论：这些结果表明，对于没有可用的自体静脉的患者，PTFE搭桥术仍然是一个值得选择的选择。在这种情况下，二次通畅率和肢体保存率是可以接受的，与报告的最好结果相比，远端静脉袖带或补片的胫腓骨假体搭桥术(1年时为74%；3年时为58%)、动静脉瘘(1年时为71%)或复合臂静脉移植(3年时分别为39%和29%)没有显著差异。
Purpose: This study was undertaken to evaluate our results of polytetrafluorethylene (PTFE) tibial and peroneal artery bypasses done for limb salvage.Methods: Within a group of patients undergoing infrainguinal limb salvage bypasses at our institution between January 1986 and May 1995, 63 patients faced an immediate amputation, had no autologous vein on duplex examination and operative exploration, and had only a tibial or peroneal artery as an outflow vessel for bypass. Most of these patients (82%) had two or more prior ipsilateral infrainguinal bypasses. These 63 patients underwent 66 PTFE bypasses to a tibial or peroneal artery without a distal anastomotic vein cuff or an adjunctive arteriovenous fistula. Our results were then compared with those reported from infrapopliteal (crural) bypasses performed with alternate autologous vein sources or PTFE in conjunction with various recommended adjuncts.Results: The 3- and 5-year cumulative primary graft patency rates for our PTFE infrapopliteal bypasses were 39% +/- 7% and 28% +/- 9%, respectively. Secondary graft patency rates were 55% +/- 8% and 43% +/- 10% at 3 and 5 years, respectively. Limb salvage rates were 71% +/- 7% at 3 years and 66% +/- 8% at 5 years. Two-year actuarial patient survival rate was only 67% +/- 7%.Conclusions: These results indicate that a PTFE bypass to an infrapopliteal artery remains a worthwhile option in patients without usable autologous vein. The secondary patency and limb salvage rates were acceptable in this setting and were not significantly different from the best results reported with prosthetic tibial/peroneal bypasses with distal vein cuffs or patches (74% at 1 year; 58% at 3 years), arteriovenous fistulas (71% at 1 year) or composite arm vein grafts (39% and 29% at 3 and 5 years, respectively).