微创技术结合外科手术治疗重症下肢缺血

目的 探讨术中血管微创治疗技术结合外科手术治疗重症下肢缺血的初步临床经验。方法 1999年7月至2000年10月,采用术中同时行髂动脉腔内微创治疗技术(球囊扩张和支架植入)结合肢体远端动脉重建术治疗广泛多节段动脉硬化闭塞症15例(20条肢体)。结果 术中17条髂动脉微创介入治疗均获成功,11条肢体同时行股-腘动脉人工血管旁路术,3条肢体行股-股-腘动脉人工血管旁路系列转流术,5条肢体行股深动脉成形术。其中有1条肢体股-腘动脉旁路术失败。本组患者无重要脏器并发症和手术死亡。平均随访时间8个月(1-16个月),髂动脉腔内支架通畅率100％,3条股-股动脉耻骨上人工血管转流均通畅,而股-腘动脉人工血管通畅率78．6％,截肢率10．0％。结论 术中髂动脉腔内微创介入治疗技术同时结合远端动脉重建术是治疗广泛多节段动脉硬化闭塞症的害全右特肯沸．     

动脉旁路手术治疗慢性下肢缺血的中远期结果

目的 探讨慢性下肢缺血的动脉旁路治疗的中远期效果.方法 回顾性分析2002年1月至2007年4月212例经动脉旁路治疗的慢性下肢缺血患者的临床资料.治疗方式包括股.膝上腘动脉旁路111例,股-膝下胭动脉旁路59例,主-髂动脉旁路25例,股股转流17例.结果 术后186例(87.7%)获随访6～68个月(中位随访期18个月),股-膝上胭动脉旁路术与股-膝下胭动脉旁路术1年初次通畅率分别为69.7%、53.5%,二次累计通畅率为81.6%、60.5%,两者差异无统计学意义(P＞0.05);其3年通畅率分别为56.3%和23.8%,两者差异有统计学意义(P＜0.05);腹主-髂股旁路与股一膝上胭动脉旁路及股股转流术近远期通畅率差异均无统计学意义(P＞0.05).随访期内52例患者行二次手术,23例行膝上或膝下截肢,保肢率为89.2%.围手术期死亡10例(4.7%),随访死亡20例,多数死于心脑血管原发疾病;人工血管感染6例.结论 根据患者病情选用适当的旁路手术方式,可取得满意的效果.股-膝上腘动脉旁路中、远期通畅率高于股-膝下胭动脉旁路,两者近期通畅率无差异.     

下肢动脉硬化性闭塞症血管重建197例分析

目的 探讨传统外科手术、血管腔内治疗和杂交手术在下肢动脉硬化性闭塞症血管重建中的应用.方法 回顾性分析1998年1月至2008年12月接受血管重建手术的197例下肢动脉硬化性闭塞症患者临床资料,其中外科手术77例,血管腔内治疗82例,杂交手术38例.探讨3种血管重建方法的适应证、治疗效果、并发症及围手术期死亡率.结果 外科手术成功率97.4%(75/77),腔内治疗90.24%(74/82),杂交手术81.58%(31/38).随访2～112个月,平均随访46个月,随诊率71%(164/197).远期通畅率在主髂和股腘动脉中外科手术(57%和51%)高丁腔内治疗(48%和42%),但差异无统计学意义;远期通畅率在多节段病变和动脉狭窄并血栓形成中杂交手术(54%、26%、28%)明显高于其他方法(48%、23%).并发症在主髂和股腘动脉中外科手术(31%、12%)明显高于血管腔内治疗(31%、11%),在多节段病变(36%)明显高于腔内治疗和杂交手术(12%、15%).外科手术对于主髂和多节段动脉病变的围手术期死亡率分别为1.5%、2.0%,其他部位病变为0%;血管腔内治疗和杂交手术均为0%.结论 对于主髂和股腘动脉,外科于术是长段闭塞性病变、血管腔内治疗是短段非闭塞性病变的首选.杂交手术对多节段病变和动脉狭窄并血栓形成更具优势.对于膝下病变,血管腔内治疗能取得较好疗效,但远期通畅率不佳.     

下肢动脉硬化性闭塞症血管重建197例分析

目的 探讨传统外科手术、血管腔内治疗和杂交手术在下肢动脉硬化性闭塞症血管重建中的应用.方法 回顾性分析1998年1月至2008年12月接受血管重建手术的197例下肢动脉硬化性闭塞症患者临床资料,其中外科手术77例,血管腔内治疗82例,杂交手术38例.探讨3种血管重建方法的适应证、治疗效果、并发症及围手术期死亡率.结果 外科手术成功率97.4%(75/77),腔内治疗90.24%(74/82),杂交手术81.58%(31/38).随访2～112个月,平均随访46个月,随诊率71%(164/197).远期通畅率在主髂和股腘动脉中外科手术(57%和51%)高丁腔内治疗(48%和42%),但差异无统计学意义;远期通畅率在多节段病变和动脉狭窄并血栓形成中杂交手术(54%、26%、28%)明显高于其他方法(48%、23%).并发症在主髂和股腘动脉中外科手术(31%、12%)明显高于血管腔内治疗(31%、11%),在多节段病变(36%)明显高于腔内治疗和杂交手术(12%、15%).外科手术对于主髂和多节段动脉病变的围手术期死亡率分别为1.5%、2.0%,其他部位病变为0%;血管腔内治疗和杂交手术均为0%.结论 对于主髂和股腘动脉,外科于术是长段闭塞性病变、血管腔内治疗是短段非闭塞性病变的首选.杂交手术对多节段病变和动脉狭窄并血栓形成更具优势.对于膝下病变,血管腔内治疗能取得较好疗效,但远期通畅率不佳.     

下肢动脉硬化性闭塞症血管重建197例分析

目的 探讨传统外科手术、血管腔内治疗和杂交手术在下肢动脉硬化性闭塞症血管重建中的应用.方法 回顾性分析1998年1月至2008年12月接受血管重建手术的197例下肢动脉硬化性闭塞症患者临床资料,其中外科手术77例,血管腔内治疗82例,杂交手术38例.探讨3种血管重建方法的适应证、治疗效果、并发症及围手术期死亡率.结果 外科手术成功率97.4%(75/77),腔内治疗90.24%(74/82),杂交手术81.58%(31/38).随访2～112个月,平均随访46个月,随诊率71%(164/197).远期通畅率在主髂和股腘动脉中外科手术(57%和51%)高丁腔内治疗(48%和42%),但差异无统计学意义;远期通畅率在多节段病变和动脉狭窄并血栓形成中杂交手术(54%、26%、28%)明显高于其他方法(48%、23%).并发症在主髂和股腘动脉中外科手术(31%、12%)明显高于血管腔内治疗(31%、11%),在多节段病变(36%)明显高于腔内治疗和杂交手术(12%、15%).外科手术对于主髂和多节段动脉病变的围手术期死亡率分别为1.5%、2.0%,其他部位病变为0%;血管腔内治疗和杂交手术均为0%.结论 对于主髂和股腘动脉,外科于术是长段闭塞性病变、血管腔内治疗是短段非闭塞性病变的首选.杂交手术对多节段病变和动脉狭窄并血栓形成更具优势.对于膝下病变,血管腔内治疗能取得较好疗效,但远期通畅率不佳.     

下肢动脉硬化性闭塞症血管重建197例分析

目的 探讨传统外科手术、血管腔内治疗和杂交手术在下肢动脉硬化性闭塞症血管重建中的应用.方法 回顾性分析1998年1月至2008年12月接受血管重建手术的197例下肢动脉硬化性闭塞症患者临床资料,其中外科手术77例,血管腔内治疗82例,杂交手术38例.探讨3种血管重建方法的适应证、治疗效果、并发症及围手术期死亡率.结果 外科手术成功率97.4%(75/77),腔内治疗90.24%(74/82),杂交手术81.58%(31/38).随访2～112个月,平均随访46个月,随诊率71%(164/197).远期通畅率在主髂和股腘动脉中外科手术(57%和51%)高丁腔内治疗(48%和42%),但差异无统计学意义;远期通畅率在多节段病变和动脉狭窄并血栓形成中杂交手术(54%、26%、28%)明显高于其他方法(48%、23%).并发症在主髂和股腘动脉中外科手术(31%、12%)明显高于血管腔内治疗(31%、11%),在多节段病变(36%)明显高于腔内治疗和杂交手术(12%、15%).外科手术对于主髂和多节段动脉病变的围手术期死亡率分别为1.5%、2.0%,其他部位病变为0%;血管腔内治疗和杂交手术均为0%.结论 对于主髂和股腘动脉,外科于术是长段闭塞性病变、血管腔内治疗是短段非闭塞性病变的首选.杂交手术对多节段病变和动脉狭窄并血栓形成更具优势.对于膝下病变,血管腔内治疗能取得较好疗效,但远期通畅率不佳.     

髂动脉支架联合球囊扩张血管成形术与人工血管转流术治疗下肢动脉硬化闭塞症的临床比较

目的:探讨分析球囊扩张血管成形术后置入髂动脉支架与人工血管转流术治疗下肢动脉硬化闭塞症的临床疗效.方法:收集下肢动脉硬化闭塞症68例患者(80条患肢)的临床资料,其中30例患者应用球囊扩张血管成形术后置入髂动脉支架治疗,38例应用人工血管转流术治疗,分析两组患者的近期临床症状的改善、疗效等级、并发症的发生等情况.结果:两组患者术后近期自觉症状均明显缓解,髂动脉支架联合球囊扩张血管成形组(总体有效率为81.58％)的自觉症状改善比人工血管转流术(总体有效率为69.05％)更明显,有效率无统计学差异(P＞0.05),但是前者的疗效等级略优于人工血管转流术组.结论:两种治疗方式治疗下肢动脉闭塞症均可明显缓解患者的自觉症状;如果患者的自身条件允许,可优先考虑析髂动脉支架联合球囊扩张血管成形术进行治疗.     

下肢动脉硬化性闭塞症血管重建197例分析

目的 探讨传统外科手术、血管腔内治疗和杂交手术在下肢动脉硬化性闭塞症血管重建中的应用.方法 回顾性分析1998年1月至2008年12月接受血管重建手术的197例下肢动脉硬化性闭塞症患者临床资料,其中外科手术77例,血管腔内治疗82例,杂交手术38例.探讨3种血管重建方法的适应证、治疗效果、并发症及围手术期死亡率.结果 外科手术成功率97.4%(75/77),腔内治疗90.24%(74/82),杂交手术81.58%(31/38).随访2～112个月,平均随访46个月,随诊率71%(164/197).远期通畅率在主髂和股腘动脉中外科手术(57%和51%)高丁腔内治疗(48%和42%),但差异无统计学意义;远期通畅率在多节段病变和动脉狭窄并血栓形成中杂交手术(54%、26%、28%)明显高于其他方法(48%、23%).并发症在主髂和股腘动脉中外科手术(31%、12%)明显高于血管腔内治疗(31%、11%),在多节段病变(36%)明显高于腔内治疗和杂交手术(12%、15%).外科手术对于主髂和多节段动脉病变的围手术期死亡率分别为1.5%、2.0%,其他部位病变为0%;血管腔内治疗和杂交手术均为0%.结论 对于主髂和股腘动脉,外科于术是长段闭塞性病变、血管腔内治疗是短段非闭塞性病变的首选.杂交手术对多节段病变和动脉狭窄并血栓形成更具优势.对于膝下病变,血管腔内治疗能取得较好疗效,但远期通畅率不佳.     

下肢动脉硬化性闭塞症血管重建197例分析

目的 探讨传统外科手术、血管腔内治疗和杂交手术在下肢动脉硬化性闭塞症血管重建中的应用.方法 回顾性分析1998年1月至2008年12月接受血管重建手术的197例下肢动脉硬化性闭塞症患者临床资料,其中外科手术77例,血管腔内治疗82例,杂交手术38例.探讨3种血管重建方法的适应证、治疗效果、并发症及围手术期死亡率.结果 外科手术成功率97.4%(75/77),腔内治疗90.24%(74/82),杂交手术81.58%(31/38).随访2～112个月,平均随访46个月,随诊率71%(164/197).远期通畅率在主髂和股腘动脉中外科手术(57%和51%)高丁腔内治疗(48%和42%),但差异无统计学意义;远期通畅率在多节段病变和动脉狭窄并血栓形成中杂交手术(54%、26%、28%)明显高于其他方法(48%、23%).并发症在主髂和股腘动脉中外科手术(31%、12%)明显高于血管腔内治疗(31%、11%),在多节段病变(36%)明显高于腔内治疗和杂交手术(12%、15%).外科手术对于主髂和多节段动脉病变的围手术期死亡率分别为1.5%、2.0%,其他部位病变为0%;血管腔内治疗和杂交手术均为0%.结论 对于主髂和股腘动脉,外科于术是长段闭塞性病变、血管腔内治疗是短段非闭塞性病变的首选.杂交手术对多节段病变和动脉狭窄并血栓形成更具优势.对于膝下病变,血管腔内治疗能取得较好疗效,但远期通畅率不佳.     

下肢动脉硬化性闭塞症血管重建197例分析

目的 探讨传统外科手术、血管腔内治疗和杂交手术在下肢动脉硬化性闭塞症血管重建中的应用.方法 回顾性分析1998年1月至2008年12月接受血管重建手术的197例下肢动脉硬化性闭塞症患者临床资料,其中外科手术77例,血管腔内治疗82例,杂交手术38例.探讨3种血管重建方法的适应证、治疗效果、并发症及围手术期死亡率.结果 外科手术成功率97.4%(75/77),腔内治疗90.24%(74/82),杂交手术81.58%(31/38).随访2～112个月,平均随访46个月,随诊率71%(164/197).远期通畅率在主髂和股腘动脉中外科手术(57%和51%)高丁腔内治疗(48%和42%),但差异无统计学意义;远期通畅率在多节段病变和动脉狭窄并血栓形成中杂交手术(54%、26%、28%)明显高于其他方法(48%、23%).并发症在主髂和股腘动脉中外科手术(31%、12%)明显高于血管腔内治疗(31%、11%),在多节段病变(36%)明显高于腔内治疗和杂交手术(12%、15%).外科手术对于主髂和多节段动脉病变的围手术期死亡率分别为1.5%、2.0%,其他部位病变为0%;血管腔内治疗和杂交手术均为0%.结论 对于主髂和股腘动脉,外科于术是长段闭塞性病变、血管腔内治疗是短段非闭塞性病变的首选.杂交手术对多节段病变和动脉狭窄并血栓形成更具优势.对于膝下病变,血管腔内治疗能取得较好疗效,但远期通畅率不佳.     

Simultaneous Hybrid Operation Common Femoral Endarterectomy and Endovascular Treatment in Multilevel Peripheral Arterial Disease with Critical Limb Ischemia

The purpose of revascularization in lower extremity arterial occlusive disease is to prevent amputation and improve walking ability. Many surgical techniques for peripheral vascular disease (PAD) have been reported. The hybrid operation composed of open surgery and endovascular procedure has been increasingly used for multilevel revascularization. The goal of this study is to evaluate feasibility of simultaneous hybrid femoral endarterectomy and endovascular treatment in patients who need multilevel revascularization with critical limb ischemia. Between March 2011 and July 2014, 38 consecutive patients (43 limbs) with multilevel peripheral arterial disease in critical limb ischemia were treated by simultaneous hybrid operation by single surgeon. The hybrid operation which combines common femoral artery endarterectomy and additive interventional procedure was simultaneously performed for multilevel revascularization. The measurements of primary outcome were primary patency rates, secondary patency rates, and limb salvage rates. Patients who underwent single procedure of surgery or intervention were excluded. The mean age was 72.48 years old and 92.1% were male. The primary and secondary patency rates at 24 months were 67.3 and 72.1%, respectively. The preoperative mean ABI of 0.51 ± 0.27 increased to postoperative mean ABI of 0.88 ± 0.35. The limb salvage rate was 95.3%. Major amputation was performed in 2 out of 43 limbs. There was no early postoperative mortality. The simultaneous hybrid operation for multilevel revascularization may be feasible to treat in multilevel PAD with high technical success and limb salvage rates, thus providing an attractive alternative to larger open surgery or endovascular procedures.     

Endovascular therapy in combination with conventional vascular surgery for the treatment of peripheral arterial obliterative disease

INTRODUCTION: In a prospective trial we analysed the results and the management of complications following a combined endovascular and vascular surgical therapy of peripheral occlusive arterial disease (POAD). PATIENTS AND METHODS: From November 1998 until January 2001 a total number of 61 patients with 64 extremities were included in this study. By preoperative angiography 19 patients had stenoses at three levels, 42 patients suffered from stenoses at two levels. The iliac axis was recanalized by intraluminal angioplasty (ITA) plus stent placement under general anesthesia. Simultaneously an infrainguinal bypass reconstruction and a local thrombendarterectomy (TEA) rsp. were performed. Intra- and postoperative complications and the patency rates as assessed by colour doppler ultrasound and angiography were analysed. RESULTS: The rate of conversion from endovascular to conventional surgery was 12.5 %. In 56 cases the endovascular therapy of the iliac axis was successful. In 28 patients a distal bypass was implanted, in 25 patients a local TEA was performed. Intraoperatively 6 dissections (10.7 %) were noted, dislocation of stents were seen in 4 patients (7.1 %), perforations occurred in 2 patients (3.6 %). Both perforations and 5/6 dissections were detected intraoperatively and were treated by endovascular means without complications. The early postoperative patency rate was 98.2 %, the secondary patency rate was 100 % and the cumulative patency rate after two years was 98.2 %. DISCUSSION: ITA and stent placement in the iliac axis can be established quickly and safely by the vascular surgeon. Intraoperative complications can be managed by endovascular means in most cases. Stent dislocation is avoidable in most cases. The complication rate after such combined endovascular therapy and conventional vascular surgery is determined by the surgical but not the endovascular part. Excellent early results and low complication rates lead to the conclusion that endovascular therapy in combination with conventional vascular surgery seems to be a reasonable supplement to the therapeutic options for the treatment of POAD.     

开放手术与腔内治疗对股腘动脉闭塞的疗效评价

目的：探讨TASC II C、D型股腘动脉闭塞的治疗效果。方法：将TASC II C、D型股腘动脉闭塞性病变178例患者回顾性分为观察组82例（开放手术组）和对照组96例（腔内治疗组）,对其疗效和并发症进行评估。结果：术后1周、3个月,观察组通畅率及踝肱指数（ABI）略高于对照组（P〉0.05）;术后6、12、24个月,观察组通畅率及ABI明显高于对照组（P〈0.05）;观察组心脑血管不良事发生率高于对照组（P〈0.01）。结论：TASC II C、D型股腘动脉慢性闭塞性病变,开放手术治疗后ABI改善情况及中远期通畅率高于腔内治疗组。     

孤立性髂动脉瘤19例诊治经验

目的 探讨孤立性髂动脉瘤(solitary iliac aneurysms,SIA)的诊治方法.方法 回顾性分析1985年1月至2008年1月23年间19例SIA患者的临床资料.其中,男性18例,女性1例,年龄39～77岁,平均(62±7)岁.19例患者中16例行择期动脉瘤切除、人工血管移植,1例行腔内修复术,1例破裂性SIA急诊行动脉瘤切除、人工血管移植,1例破裂性SIA未手术即死亡.结果 19例患者共有30个SIA,其中25个(83.3%)位于髂总动脉,4个(13.3%)位于髂内动脉,1个(3.3%)髂外动脉瘤.11例(57.9%)患者具有多发性动脉瘤,其中9例(47.4%)为双侧髂动脉瘤,另2例合并其他部位的动脉瘤.2例(10.5%)合并动脉闭塞性疾病.2例破裂SIA,1例抢救成功,1例抢救无效死亡.开腹手术的17例患者无围手术期死亡,无盆腔脏器缺血等并发症;1例腔内修复术治疗后无内漏等并发症.术后移植血管通畅,无新发动脉瘤形成早期诊断和治疗SIA非常重要,应通过CTA等方法明确诊断及有否合并多发性动脉瘤或动脉闭塞性疾病.SIA的手术效果良好,术后应长期随访,注意有否吻合口动脉瘤或新生动脉瘤.     

Endovascular treatment of iliac occlusive disease: review and update

Use of endovascular interventions for arterial occlusive lesions continues to increase. With the evolution of the technology supporting these therapeutic measures, the results of these interventions continue to improve. In general, a comparison of techniques for revascularization of iliac occlusive diseases shows similar initial technical success rates for open versus percutaneous transluminal angioplasty. Angioplasty is often associated with lower periprocedural morbidity and mortality rates. Conversely, surgery frequently provides greater long-term patency, although late failure of percutaneous therapies may occur but still can be treated successfully with reintervention. The perpetual buildup of experience with angioplasty and stenting will eventually characterize its role in the management of occlusive disease. This review outlines the current consensus and applicability of endovascular management of iliac occlusive diseases.     

椎动脉闭塞性病变的手术治疗的疗效分析

目的:探讨开放手术治疗椎动脉闭塞性病变的疗效。方法:回顾性分析2013—2014年收治的7例椎动脉闭塞性病变患者资料,患者分别行动脉旁路转流术或动脉内膜剥脱术等,根据术后复查、随访情况评估手术疗效。结果:全部手术患者症状均得到缓解,顺利出院,手术技术成功率100%。围术期无明显并发症发生,术后复查椎动脉血流通畅,近期通畅率100%,术后2年内无明显头晕等症状复发。结论:对于椎动脉闭塞性病变,手术治疗可取得良好效果,术后通畅率较高。     

Outcome of lower extremity revascularization for peripheral artery occlusive disease: is there a difference between men and women?

The incidence of peripheral arterial occlusive disease (PAD) increases with age. Women represent a growing percentage of the elderly population who present with PAD. While speculation exists that gender affects outcome after revascularization procedures, the literature is confusing and often conflicting. This review compares outcomes by gender after open surgical and endovascular lower extremity revascularization (LER) procedures including: demographic differences, patency rates, limb salvage rates, long-term survival, perioperative complications and 30-day mortality. This review summarizes the existing data and discusses current influences on outcome after LER.     

358例下肢动脉硬化闭塞症外科治疗效果分析

目的 分析慢性下肢动脉硬化闭塞症外科治疗方法及疗效.方法 回顾性分析2002年1月至2007年7月序贯治疗的358例慢性下肢动脉硬化闭塞症患者接受动脉搭桥或介入治疗后远期疗效.结果 男293例,女65例,年龄(66 ±10)岁.本组接受了包括搭桥手术、介入治疗、截肢(趾)等外科治疗共413例(次).失访48例,随访率86.6%,随访时间6～64个月.髂动脉支架介入治疗术后1、2、3年初次开通率高于腹主-髂-股动脉人工血管搭桥,差异无统计学意义(P＞0.05),也高于股(腘)动脉支架介入治疗术后初次开通率,但差异有统计学意义(P＜0.05).股-腘动脉膝上人工血管搭桥术后1年的初次开通率略高于膝下搭桥,但差异无统计学意义(P＞0.01);术后2、3年初次开通率均高于膝下搭桥,差异有统计学意义(P＜0.01).股浅动脉球囊扩张成形术术后1年通畅率略低于腘动脉以远的球囊扩张术,但差异无统计学意义(P＞0.05).全组截肢率为10.3%(37/358),围术期死亡率3.9%(14/358),随访期死亡率6.4%(23/358).结论 下肢动脉硬化患者根据病情选择适当的外科治疗方式,可以获得较高的术后通畅率.     

Trends in mortality,readmissions, and complications after endovascular and open infrainguinal revascularization

BackgroundAlthough short-term outcomes of endovascular and open infrainguinal revascularization in patients with peripheral arterial disease have been previously reported, 30-day readmission and resource utilization after these procedures remain unknown.MethodsWe used the 2010–2014 Nationwide Readmissions Database and the International Classification of Diseases, Ninth Edition, to identify patients with peripheral arterial disease undergoing either in-hospital endovascular or open infrainguinal revascularization.ResultsOf an estimated 574,201 hospitalized patients treated for peripheral arterial disease, 308,056 and 266,145 underwent lower limb endovascular and open infrainguinal revascularization, respectively. Compared with patients who underwent open revascularization, endovascular patients were more commonly female (44.8% vs 36.7%, P < .001) and older (69.5 vs 67.2 years, P < .001). Moreover, they had higher rates of 30-day readmission (15.6% vs 13.5%, P < .001), in-hospital complications (22.3% vs 20.9%, P < .001), and in-hospital index mortality (2.1% vs 1.8%, P < .001). In contrast, risk-adjusted multivariable analysis found open revascularization to be independently associated with increased odds of 30-day readmission (odds ratio, 1.13; 95% confidence interval 1.10–1.16), index complications (odds ratio, 1.23; 95% confidence interval 1.20–1.27), and mortality (odds ratio, 1.26; 95% confidence interval 1.16–1.36) compared with those who underwent endovascular revascularization. Trend analysis revealed an overall decrease in the utilization of both endovascular and open revascularization procedures in the inpatient setting.ConclusionDespite lower rates of adverse events compared to endovascular, open infrainguinal revascularization is independently associated with increased risk of short-term readmission, complications, and mortality. These findings should be considered in the selection of appropriate surgical therapy for lower extremity arterial occlusive disease.     

杂交手术治疗TASC D型下肢动脉硬化闭塞症的临床分析

目的 评价杂交手术治疗TASC D型下肢动脉硬化闭塞症的临床疗效.方法 回顾性分析2006年1月至2009年12月间采用杂交手术治疗的46例TASC D型下肢动脉硬化闭塞症患者(共48条患肢)的临床资料.其中男性32条患肢,女性16条患肢;年龄54～85岁,平均67岁.根据临床症状进行Fontaine分级,根据开放手术与腔内治疗部位的相对关系进行分组,采用Kaplan-Meier生存曲线比较不同分级、分组患者间一期通畅率的差异,分析影响一期通畅率的危险因素.结果 所有患者手术均获成功.术后41条患肢(85.4%)临床症状明显改善,平均踝肱指数0.63±0.18,高于术前的0.24±0.13(P＜0.05);平均间歇性跛行距离从术前(87±48)m提高至(247±62)m(P＜0.05).平均随访27.1个月,一期通畅率为79.2%,辅助一期通畅率为83.3%,二期通畅率为95.8%.生存分析显示FontaineⅡ级患者一期通畅率明显高于Ⅲ、Ⅳ级(P均＜0.05);当对开放手术治疗动脉段的远近端都进行腔内干预时,其一期通畅率要低于仅在其近端或远端一侧干预者(P值均＜0.05).Cox回归分析发现糖尿病和高血脂是影响术后一期通畅率的独立因素(P=0.013、0.008).结论 杂交手术是治疗TASC D型下肢动脉硬化闭塞症的有效方法,适用于高危重症患者.