当前位置： SCI文献检索 > AMERICAN JOURNAL OF SURGERY期刊下所有文献 > Noninvasive predictors of patency for infrapopliteal PTFE bypasses with combined arteriovenous fistula and vein interposition technique.

Noninvasive predictors of patency for infrapopliteal PTFE bypasses with combined arteriovenous fistula and vein interposition technique.

Abstract：

BACKGROUND:Despite recent increased indications for infrapopliteal prosthetic bypass grafts with complementary arteriovenous fistulas, objective documentation of improved perfusion to the foot is lacking. In addition, the value of post operative noninvasive testing in the prediction of bypass success remains unclear. PATIENTS AND METHODS:Over a 3-year period, 41 patients with limb-threatening ischemia were treated with 41 infrapopliteal 6-mm polytetrafluoroethylene (PTFE) bypasses with a complementary arteriovenous fistula at our institution. Twenty-four patients were men and 17 were women, with an average age 71.3 +/- 8.6 years. Thirty-one patients (76%) had undergone at least 1 previous failed ipsilateral arterial bypass. Preoperative and early postoperative (less than 1 month) pulse-volume recordings of transmetatarsal amplitude (TMA) were available for analysis in 28 patients. Postoperative duplex evaluations of graft velocity, fistula patency, and prograde distal arterial flow were performed in 26 of the original 41 patients. These data were correlated to early graft failure in an attempt to identify specific noninvasive predictors. RESULTS:Cumulative primary patency rates of the original 41 patients were 79.0%, 69.2%, and 63.8% at 1, 2, and 3 years, respectively. The early postoperative TMA values ranged from 3 to 50 mm with a mean of 21.6 +/- 14.8 mm (P < 0.001). Twenty-one patients (75%) had patent grafts on follow-up of 2 to 37 months (mean 18.6). The early postoperative TMA in this group of patients was 26.5 +/- 12.4 mm compared with 3.3 +/- 2.8 mm in the 6 patients whose grafts failed within 6 months (P < 0.001). A TMA of < 5 mm was 83% sensitive and 95% specific for the prediction of early graft failure. Of the graft examined by duplex ultrasonography, 21 (81%) remained patent during the follow-up period. The midgraft peak systolic velocity (PSV) of these grafts was 109 +/- 8.0 cm/s compared with 74.2 +/- 15.3 cm/s for the 5 initially patent bypasses that subsequently failed at any time during the follow-up period (P < 0.05). PSV of < 70 cm/s was 60% sensitive and 86% specific in predicting early graft failure. The combination of early postoperative TMA < 5 mm and early midgraft PSV < 70 cm/s was 100% sensitive and 100% specific for the prediction of early graft failure. CONCLUSIONS:These data show that infrapopliteal PTFE arterial bypasses with complementary arteriovenous fistulas significantly improve arterial perfusion at the level of the foot in the majority of patients. Also, both the postoperative TMA and midgraft PSV appear to be reliable predictors of graft outcome. Further experience with the noninvasive surveillance of these bypasses may become as rewarding as it is in standard vein bypasses.

journal_name

Am J Surg

journal_title

American journal of surgery

authors

Ascer E,Pollina RM,Gennaro M,Lorensen E

doi

10.1016/s0002-9610(99)80264-5

subject

Has Abstract

pub_date

1995-08-01 00:00:00

pages

103-5

issue

eissn

0002-9610

issn

1879-1883

pii

S0002-9610(99)80264-5

journal_volume

170

pub_type

杂志文章

在线工具

Noninvasive predictors of patency for infrapopliteal PTFE bypasses with combined arteriovenous fistula and vein interposition technique.