股-腘人工血管移植术后再闭塞病因及相关治疗
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摘要
目的分析股-腘人工血管移植术后移植血管再闭塞的病因以及相关治疗措施。方法选取2015年3月至2017年3月诊治的行股-膝上腘血管旁路移植手术(单/双侧)的全身动脉硬化闭塞症(ASO)患者82例,患肢共88条。分析影响患者术后移植血管再闭塞的影响危险因素及有效的治疗措施。结果术后即时、术后6、12、24个月时患者移植血管累积通畅率分别为90. 91%、87. 12%、84. 31%和82. 56%。COX回归分析显示影响患肢血管再闭塞的危险因素有术前并存糖尿病、高脂血症、既往吸烟史和术前膝下仅有1条流出道通畅(P均<0. 05)。根据Kaplan-Meier法计算的术后6、12、24个月累积通畅率结果,术后6、12个月统计,闭塞组患者吸烟史分别为72. 73%、76. 92%,明显高于通畅组的31. 88%、33. 33%(P <0. 05,P <0. 01);术后24个月统计,闭塞组患者糖尿病为64. 29%、吸烟史为71. 43%、术前膝下仅有1条流出道通畅者为57. 14%,明显高于通畅组(23. 40%,31. 91%,21. 28%,P <0. 05,P <0. 01)。结论股-腘动脉人工血管移植术后血管再闭塞的危险因素有术前并存高脂血症、糖尿病、术前膝下仅1条流出道通畅及有吸烟史,而后三者是股-腘动脉旁路术后远期再闭塞的危险因素。对于以上危险因素进行对症治疗,可提高股-腘人工血管移植术后通畅率。
Objective To analyze the reason of reocclusion of vascular prosthesis after femoral-popliteal artificial blood vessel grafting and the relative treatment measures. Methods A total of 82 patients( 88 affected limbs) with systemic arteriosclerosis obliterans( ASO) who underwent bypass grafting( single/bilateral) of femoral and popliteal above-knee vessels from March 2015 to March 2017 were selected. The risk factors influencing reocclusion of vascular prosthesis after femoral-popliteal artificial blood vessel grafting and the effective treatment measures were analyzed. Result The cumulative patency rates immediately after operation and at 6-,12-and 24-month after operation were 90. 91%,87. 12%,84. 31% and 82. 56%,respectively. COX regression analysis showed that smoking history,preoperative coexisted with diabetes mellitus,hyperlipidemia and preoperative patency of only one outflow tract below the knee were the risk factors for revascularization( all P < 0. 05). According the results of cumulative patency rate calculated by Kaplan-Meier method,at6-,12-month after operation the incidences of preoperative smoking history in the occlusion group( 72. 73%,76. 92%)were significantly higher than those in the patency group( 31. 88%,33. 33%)( P < 0. 05,P < 0. 01); while at 24-month after operation,the incidences of preoperative concurrent diabetes,smoking history and preoperative patency of only one outflow tract below the knee in the occlusion group( 64. 29%,71. 43%,57. 14%) were significantly higher than those in the patency group( 23. 40%,31. 91%,21. 28%)( P < 0. 05 or P < 0. 01). Conclusions The risk factors of reocclusion of vascular prosthesis after femoral-popliteal artificial blood vessel grafting are diabetes,hyperlipidemia,only one outflow pathway patency below the knee and smoking history before operation,while the late three are the risk factors of long-term reocclusion after femoral-popliteal artery bypass. The symptomatic treatment should be taken for directing against the above risk factors to improve the patency rate of femoral-popliteal artificial blood vessel.
Objective To analyze the reason of reocclusion of vascular prosthesis after femoral-popliteal artificial blood vessel grafting and the relative treatment measures. Methods A total of 82 patients( 88 affected limbs) with systemic arteriosclerosis obliterans( ASO) who underwent bypass grafting( single/bilateral) of femoral and popliteal above-knee vessels from March 2015 to March 2017 were selected. The risk factors influencing reocclusion of vascular prosthesis after femoral-popliteal artificial blood vessel grafting and the effective treatment measures were analyzed. Result The cumulative patency rates immediately after operation and at 6-,12-and 24-month after operation were 90. 91%,87. 12%,84. 31% and 82. 56%,respectively. COX regression analysis showed that smoking history,preoperative coexisted with diabetes mellitus,hyperlipidemia and preoperative patency of only one outflow tract below the knee were the risk factors for revascularization( all P < 0. 05). According the results of cumulative patency rate calculated by Kaplan-Meier method,at6-,12-month after operation the incidences of preoperative smoking history in the occlusion group( 72. 73%,76. 92%)were significantly higher than those in the patency group( 31. 88%,33. 33%)( P < 0. 05,P < 0. 01); while at 24-month after operation,the incidences of preoperative concurrent diabetes,smoking history and preoperative patency of only one outflow tract below the knee in the occlusion group( 64. 29%,71. 43%,57. 14%) were significantly higher than those in the patency group( 23. 40%,31. 91%,21. 28%)( P < 0. 05 or P < 0. 01). Conclusions The risk factors of reocclusion of vascular prosthesis after femoral-popliteal artificial blood vessel grafting are diabetes,hyperlipidemia,only one outflow pathway patency below the knee and smoking history before operation,while the late three are the risk factors of long-term reocclusion after femoral-popliteal artery bypass. The symptomatic treatment should be taken for directing against the above risk factors to improve the patency rate of femoral-popliteal artificial blood vessel.
引文
[1]宋庆宏,江涛,栗力.股-腘动脉人工血管移植术后再闭塞的腔内治疗[J].中华普通外科杂志,2016,31(8):647-649.
[2]李杨,郭建明,谷涌泉.股腘动脉支架内再狭窄的腔内治疗研究进展[J].中华老年心脑血管病杂志,2016,18(8):873-875.
[3]耿家威,胡何节,方征东,等.下肢动脉血管旁路移植术后再闭塞的影响因素分析[J].中国临床保健杂志,2017,20(4):349-353.
[4]刘力生.中国高血压防治指南2010[J].中华心血管病杂志,2011,3(7):42-93.
[5]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,16(10):15-35.
[6] Ma X,Zhang YL,Ji Q,et al. Diagnostic criteria for diabetes in China:are we pushing too much beyond evidence?[J]. Eur J Clin Nutr,2017,71(7):812-815.
[7]李阳春,栗力,曹月娟,等.糖尿病患者股-腘人工血管移植术后再闭塞的治疗[J].中华普通外科杂志,2017,32(2):167-168.
[8]姚晔,张文龙,李琼,等.股腘动脉双通路介入治疗股浅动脉慢性完全闭塞[J].介入放射学杂志,2016,25(11):1002-1006.
[9]张培华.临床血管外科[M].北京:科学出版社,2003:501-503.
[10]潘长玉,高妍. 2型糖尿病下肢血管病变发生率及相关因素调查[J].中国糖尿病杂志,2001,9(6):323.
[11] SibéM,Kaladji A,Boirat C,et al. French multicenter experience with the GORE TIGRIS Vascular Stent in superficial femoral and popliteal arteries[J]. J Vasc Surg,2017,65(5):1329-1335.
[12] Ridker PM. LDL cholesterol:controversies and future therapeutic directions[J]. The Lancet,2014,384(9943):607-617.
[13] Gurupatham S,Harlock J,Andrinopoulos T. Comparison of Superior Femoral Artery Angioplasty Combined With Open Femoral Endarterectomy to Open Surgical Bypass for Femoropopliteal Occlusive Disease[J]. J Vasc Surg,2016,64(5):1542-1543.
[14]符伟国,岳嘉宁.股腘动脉段病变支架内再狭窄的腔内治疗策略分析[J].中华外科杂志,2016,54(8):586-590.
[15] Gaudino M,Niccoli G,Roberto M,et al. The Same Angiographic Factors Predict Venous and Arterial Graft Patency:A Retrospective Study[J]. Medicine,2016,95(1):e2068.
[2]李杨,郭建明,谷涌泉.股腘动脉支架内再狭窄的腔内治疗研究进展[J].中华老年心脑血管病杂志,2016,18(8):873-875.
[3]耿家威,胡何节,方征东,等.下肢动脉血管旁路移植术后再闭塞的影响因素分析[J].中国临床保健杂志,2017,20(4):349-353.
[4]刘力生.中国高血压防治指南2010[J].中华心血管病杂志,2011,3(7):42-93.
[5]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,16(10):15-35.
[6] Ma X,Zhang YL,Ji Q,et al. Diagnostic criteria for diabetes in China:are we pushing too much beyond evidence?[J]. Eur J Clin Nutr,2017,71(7):812-815.
[7]李阳春,栗力,曹月娟,等.糖尿病患者股-腘人工血管移植术后再闭塞的治疗[J].中华普通外科杂志,2017,32(2):167-168.
[8]姚晔,张文龙,李琼,等.股腘动脉双通路介入治疗股浅动脉慢性完全闭塞[J].介入放射学杂志,2016,25(11):1002-1006.
[9]张培华.临床血管外科[M].北京:科学出版社,2003:501-503.
[10]潘长玉,高妍. 2型糖尿病下肢血管病变发生率及相关因素调查[J].中国糖尿病杂志,2001,9(6):323.
[11] SibéM,Kaladji A,Boirat C,et al. French multicenter experience with the GORE TIGRIS Vascular Stent in superficial femoral and popliteal arteries[J]. J Vasc Surg,2017,65(5):1329-1335.
[12] Ridker PM. LDL cholesterol:controversies and future therapeutic directions[J]. The Lancet,2014,384(9943):607-617.
[13] Gurupatham S,Harlock J,Andrinopoulos T. Comparison of Superior Femoral Artery Angioplasty Combined With Open Femoral Endarterectomy to Open Surgical Bypass for Femoropopliteal Occlusive Disease[J]. J Vasc Surg,2016,64(5):1542-1543.
[14]符伟国,岳嘉宁.股腘动脉段病变支架内再狭窄的腔内治疗策略分析[J].中华外科杂志,2016,54(8):586-590.
[15] Gaudino M,Niccoli G,Roberto M,et al. The Same Angiographic Factors Predict Venous and Arterial Graft Patency:A Retrospective Study[J]. Medicine,2016,95(1):e2068.