A 10-year experience with complementary distal arteriovenous fistula and deep vein interposition for infrapopliteal prosthetic bypasses.
A 10-year experience with complementary distal arteriovenous fistula and deep vein interposition for infrapopliteal prosthetic bypasses.
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DOI：
10.1177/153857440503900504
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发表时间：
2005-09-01
影响因子：
0.9
通讯作者：
Jacob, Theresa
中科院分区：
文献类型：
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作者：
Hingorani, Anil P;Ascher, Enrico;Jacob, Theresa
由于接受下肢血运重建术的患者中有20%没有足够的静脉管道，一些作者探索了使用人工血管移植物与下肢血运重建的连续技术。然而，这些手术的长期移植物通畅性尚未得到很好的记录。本研究的目的是检查聚四氟乙烯（PTFE）旁路与连续性动静脉内瘘和静脉间置（AVF/VI）用于膝下血运重建的长期通畅性。在10年的时间里，对176例（71.5%男性）严重缺血患者进行了246次下肢重建，其中完全自体静脉搭桥术不可行。76条肢体接受了1次或多次失败的同侧腹股沟下旁路术。手术适应症为慢性严重肢体缺血（86%）（静息痛、缺血性溃疡或坏疽）或急性缺血（14%）。年龄范围为46 - 91岁（平均74 +/-0.6 [SD]岁）。糖尿病、高血压、冠状动脉疾病、终末期肾病和吸烟等危险因素分别占49%、49%、52%、8%和67%。在随访期间，112例（45%）需要再次干预。27例患者（15%）需要两次旁路翻修。在随访期间，56条肢体（23%）被截肢（膝上截肢25条（10%）;膝下截肢31条（13%））。迄今为止，在总共176名患者中，有150名（85%）死亡。一期移植物通畅率如下：1年51%; 2年41%; 3年35%; 5年24%。保肢率如下：1年，79%; 2年，76%; 3年，76%; 5年，74%。患者生存率如下：1年，69%; 2年，60%; 3年，54%;和5年，40%。无截肢患者生存率如下：1年，66%; 2年，57%; 3年，51%; 5年，30%。对于自体旁路移植术不可行的患者，该技术似乎提供了合理的通畅率和保肢率。
Since up to 20% of patients undergoing lower extremity revascularization do not have an adequate venous conduit, some authors have explored the use of prosthetic grafts with adjunctive techniques for lower extremity revascularization. However, the long-term graft patency of those procedures has not been well documented. The purpose of this study was to examine the long-term patency of polytetrafluoroethylene (PTFE) bypass with adjunctive arteriovenous fistula and venous interposition (AVF/VI) for infrapopliteal revascularization. Over a 10-year period, 246 lower extremity reconstructions were performed in 176 (71.5% men) patients with critical ischemia in whom a totally autogenous vein bypass was not feasible. Seventy-six limbs had undergone 1 or more failed ipsilateral infrainguinal bypasses. Indications for surgery were chronic critical limb-threatening ischemia (86%) (rest pain, ischemic ulcer, or gangrene) or acute ischemia (14%). Ages ranged from 46 to 91 years (mean 74 +/-0.6 [SD] years). Risk factors such as diabetes, hypertension, coronary artery disease, end-stage renal disease, and use of tobacco were present in 49%, 49%, 52%, 8%, and 67% of the patients, respectively. During the follow-up, 112 cases (45%) required reinterventions. Twenty-seven patients (15%) required bypass revision twice. During the follow up, 56 limbs (23%) were amputated (above-the-knee amputation 25 (10%); below-the-knee amputation 31 (13%). To date, 150 (85%) patients of a total of 176 are deceased. The primary graft patency rates were as follows: at 1 year, 51%; at 2 years, 41%; 3 years, 35%; and 5 years, 24%. Limb salvage rates were as follows: 1 year, 79%; 2 years, 76%; 3 years 76%; and 5 years, 74%. Patient survival rates were as follows: 1 year, 69%; 2 years, 60%; 3 years, 54%; and 5 years, 40%. Amputation-free patient survival rates were as follows: 1 year, 66%; 2 years, 57%, 3 years, 51%, and 5 years, 30%. This technique appears to offer reasonable patency and limb salvage rates in patients in whom autogenous bypass grafts are not feasible.