Outcome of infra-inguinal bypass grafts using vein conduit with less than 3 millimeters diameter in critical leg ischemia
Outcome of infra-inguinal bypass grafts using vein conduit with less than 3 millimeters diameter in critical leg ischemia
复制标题
DOI：
10.1016/j.jvs.2010.09.014
复制
发表时间：
2011-02-01
影响因子：
4.3
通讯作者：
Rashid, Hisham
中科院分区：
文献类型：
--
作者：
Slim, Hani;Tiwari, Alok;Rashid, Hisham
目的：评价内径为3mm的重症腿缺血（CLI）患者行腹股沟下旁路移植术后无截肢生存率和通畅率的差异。方法：回顾性分析所有连续行腹股沟下旁路移植术的CLI患者。术前对所有患者进行双工扫描测绘和潜在静脉移植物测量。患者被招募参加为期1年的双扫描移植物监测项目。主要终点是术后1年无截肢生存和通畅率。采用Kaplan-Meier检验和chi(2)检验进行统计分析。结果：2004年1月至2010年4月，157例CLI患者通过静脉导管进行了171次旁路手术（男性111例，女性46例，中位年龄75岁，范围45-96岁）。93例（54.4%）因组织丢失进行了旁路手术，44例（25.7%）因坏疽和休息疼痛进行了旁路手术。157例患者中，糖尿病113例（72.0%），肾病40例（25.5%），高血压131例（83.4%），缺血性心脏病64例（40.8%）。38例（22.2%）行股腘动脉旁路手术，133例（77.8%）行股远端旁路手术。所有病例均采用自体大隐静脉（GSV）。所有移植物均被逆转。31条（18%）静脉导管直径为2mm。在两组中，需要双扫描监测，然后对有威胁的移植物进行早期补救性血管成形术，以获得良好的通畅率。（中华外科杂志2011；53:421-5）
Objective: The purpose of this study was to evaluate the difference in amputation-free survival and patency rates of infra-inguinal bypass grafts in patients with critical leg ischemia (CLI) with vein conduits with an internal diameter = 3 mm.Methods: Retrospective analysis of all consecutive patients with CLI undergoing infra-inguinal bypass. Preoperative duplex scan mapping and measurement of potential vein grafts were performed on all patients. Patients were recruited in a 1-year duplex scan graft surveillance program. Primary end points were amputation-free survival and patency rates at 1 year postoperatively. Kaplan-Meier and chi(2) test were used for statistical analysis.Results: Between January 2004 and April 2010, 157 consecutive patients with CLI underwent 171 bypasses using vein conduits ( 111 men, 46 women; median age, 75 years; range, 45-96 years). Ninety-three bypasses (54.4%) were performed for tissue loss, 44 (25.7%) for gangrene, and for rest pain. Of the 157 patients, 113 (72.0%) had diabetes mellitus, 40 (25.5%) hid renal impairment, 131 (83.4%) had hypertension, and 64 (40.8%) had ischemic heart disease. Femoropopliteal bypass was performed in 38 cases (22.2%), whereas 133 (77.8%) of the bypasses were femoro-distal. Autogenous great saphenous vein (GSV) was used in all cases. All grafts were reversed. The diameter of 31 (18%) vein conduits measured 2 mm in diameter in patients with CLI. Duplex scan surveillance followed by early salvage angioplasty for threatened grafts is needed to achieve good patency rates in both groups. (J Vasc Surg 2011;53:421-5.)