肝素涂层人工血管在腔内治疗失败的严重下肢缺血血运重建中的应用

目的:评价肝素涂层人工血管在腔内治疗失败的严重下肢缺血(CLI)患者行下肢动脉旁路移植术中的疗效。方法:回顾性分析2017年10月至2019年4月北京医院血管外科收治的腔内治疗失败的CLI患者行下肢动脉旁路移植术治疗的临床资料,根据患者临床症状、病变特点,选择个性化治疗方案,包括支架取出术、动脉内膜剥脱和成形术、人工血管或人工血管复合自体静脉旁路移植术等多种手术方式完成下肢动脉血运重建。分析围术期并发症、症状缓解和溃疡伤口愈合情况、桥血管通畅率及保肢率。结果:入组患者共27例,其中16例静息痛患者术后疼痛均有效缓解,11例有足部溃疡和组织坏死者中,9例完全愈合,2例术后半年溃疡面缩小。术后并发症6例,术后30 d无死亡病例。所有患者获得随访,随访时间为(13.0±8.9)个月(范围:2~35个月)。通过Kaplan-Meier曲线计算,术后6、12及24个月一期通畅率分别为83.3%、73.7%及49.1%;二期通畅率分别为91.8%、82.1%及70.8%;保肢率分别为91.8%、86.9%及76.6%。其中15例股-腘动脉旁路移植术术后1、2年一期通畅率分别为86.7%、49.5%;二期通畅率分别为93.3%、81.7%;保肢率分别为93.3%、81.7%。8例股-小腿动脉旁路移植术术后1、2年一期通畅率分别为45.0%、45.0%;二期通畅率分别为58.3%、58.3%;保肢率分别为58.3%、58.3%。结论:肝素涂层人工血管动脉旁路移植术为腔内治疗失败的下肢动脉复杂病变提供了一种安全有效的治疗方式,能够有效缓解症状及提高保肢率。

Heparin-bonded grafts revascularization in patients with critical limb ischemia following endovascular intervention failure

Objective To evaluate the efficacy and safety of heparin-bonded graft revascularization in patients with critical limb ischemia(CLI)after failed endovascular intervention.Methods The clinical data of patients who underwent lower extremity bypass after failed endovascular intervention for CLIs from Oct.2017 to Apr.2019 were retrospectively analyzed.Individualized surgical therapy including stent removal,endarterectomy,graft or graft combined with autogenous vein bypass and other surgical methods to gain arterial revascularization of the lower extremity was designed based on the patients'symptoms and clinical features.Clinical characteristics,individual surgical therapeutic information,perioperative complications,symptom relief,ulcer wound healing,patency rate and limb salvage rate were analyzed.Results A total of 27 patients were enrolled in this study.Resting pain of 16 cases relieved effectively.Among 11 cases of ulcer and tissue necrosis,9 cases healed completely and 2 cases of ulcer reduced obviously half a year after operation.Postoperative complications occurred in 6 cases,with no perioperative death occurred.All patients were followed up for(13.0±8.9)months(range:2-35 months).Kaplan-Meier estimated patency and limb salvage rate.Overall primary patency at 6-,12-and 24-month was 83.3%,73.7%and 49.1%,respectively;secondary patency was 91.8%,82.1%and 70.8%,respectively;limb salvage was 91.8%,86.9%and 76.6%,respectively.In the subgroup of femoropopliteal bypass,the 1-and 2-year primary patency rate was 86.7%and 49.5%,respectively;secondary patency was 93.3%and 81.7%,respectively;limb salvage was 93.3%and 81.7%,respectively.In the subgroup of femorocrural bypass,the 1-and,2-year primary patency rate was 45.0%and 45.0%,respectively;secondary patency was 58.3%and 58.3%,respectively;limb salvage was 58.3%and 58.3%,respectively.Conclusion In the era of endovascular intervention,traditional arterial bypass can still provide a safe and effective alternative treatment for complex lesions of lower extremity arteries with failed endovascular intervention.It can efectively relive symptoms and improve limb salvage rate.