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在使用替代导管进行下 inguinal 绕道术后,无截肢生存和伤口愈合的预测因素

Zachary A Matthay¹, William A Pace¹, Eric J Smith²

¹Department of Surgery, University of California, San Francisco, San Francisco, CA.

Journal of vascular surgery

|February 4, 2024

概括

对于慢性肢体威胁性缺血症 (CLTI),自身手臂/拼接静脉或PTFE绕道提供了比冷保存静脉移植更好的无截肢生存率 (AFS). 在高风险患者中,应谨慎使用冷保存的移植物.

科学领域:

血管外科血管外科
肢体救援手术肢体救援手术
再生医学是一种再生医学.

背景情况:

自主单段大沙静脉 (ssGSV) 通常不适合在慢性四肢威胁性缺血症 (CLTI) 中进行下 inguinal 绕道.
使用替代导管用于CLTI绕道的结果的预测因素尚未确定.

研究的目的:

在CLTI患者中使用替代导管研究患者的结果,特别是无截肢生存期 (AFS),在使用替代导管的下 inguinal 绕道后.
根据四肢呈现,绕道目标和导管类型来确定AFS的预测因素.

主要方法:

针对CLTI (2013-2020年) 的139个下指旁路的回顾性分析.
导管包括冷保存的ssGSV (cryovein),聚四乙烯 (PTFE) 和手臂/接静脉移植.
使用多变量Cox比例危险和AFS预测器的分类和回归树模型进行分析.

主要成果:

两年的AFS为化静脉的53%,拼接/手臂静脉的78%,PTFE的79%.
化使用与明显较低的AFS相关 (调整后危险比,2.5;P=.02).
在冷凝组中,WIfI阶段3/4,年龄大于70岁,先前的绕道术失败预测了最低的AFS (36%).

结论:

自生臂/拼接静脉和 PTFE 导管在 ssGSV 不存在时,在 CLTI 绕道中表现出优异的 AFS 与 cryovein 相比.
克里奥维恩移植,尽管穿透率较低,但在大多数情况下,伤口愈合.
在老年CLTI患者中,应谨慎使用Cryovein,这些患者患有高WIfI阶段和以前由于AFS不佳而失败的旁路术.

关键词:

慢性肢体威胁性缺血症可能会导致肢体缺血.肢体的救援工作进行血管移植.

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