Secondary endovascular procedures improve overall patency and limb salvage in patients undergoing in situ saphenous vein infragenicular bypass.

IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Surgery Pub Date : 2023-08-01 DOI:10.23736/S0021-9509.22.12207-X
Nicola Troisi, Daniele Adami, Stefano Michelagnoli, Raffaella Berchiolli
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Abstract

Background: Secondary interventions strongly improves patency and limb salvage rates in patients undergoing infrainguinal vein bypass. The aim of this study was to evaluate the influence of secondary endovascular procedures performed during the follow-up on patency and limb salvage in patients with critical limb-threatening ischemia (CLTI) undergoing in situ saphenous vein infragenicular bypass.

Methods: From January 2018 to December 2019 541 patients in 43 centers have been enrolled into the LIMBSAVE registry (treatment of critical Limb IschaeMia with infragenicular Bypass adopting in situ SAphenous VEin technique). In all patients a strict surveillance program with Duplex scan was established (1, 3, 6, 9, 12, 18, 24 months). During the follow-up indications for endovascular procedures were anastomotic stenoses, improvement of run-in (iliac stenosis) or run-off (tibial vessels' stenoses or occlusions). Two-year estimated outcomes in terms of overall patency, and limb salvage were analyzed by life-table analysis (Kaplan-Meier test). Outcomes obtained in patients undergoing endovascular procedure (Group-endo) were compared by means of Gehan-Breslow-Wilcoxon Test with those obtained in patients with no secondary endovascular procedure during the follow-up (Group-no endo).

Results: Two groups were homogeneous in terms of demographics and intraprocedural details. Overall mean duration of follow-up was 12.1 months (range 1-24). During the follow-up period (>30 days) 55 endovascular procedures were performed in 49 patients (9.1%) (Group-endo). Most of endovascular procedures (37/55, 67.3%) was performed to treat stenoses at proximal or distal anastomosis. Secondary endovascular procedures (40/55, 72.7%) were predominantly performed within 6 months from the index procedure. Estimated 2-year overall patency (97.9% vs. 85.2%, P=0.05), and limb salvage (100% vs. 93.9%, P=0.05) rates were significantly better in Group-endo.

Conclusions: Secondary endovascular procedures in patients with CLTI undergoing in situ saphenous infragenicular bypass significantly improve the rates of overall patency and limb salvage in the mid-term period.

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继发性血管内手术可改善原位隐静脉细静脉搭桥患者的整体通畅和肢体保留。
背景:二次干预能显著提高腹股沟下静脉搭桥术患者的通畅率和肢体保留率。本研究的目的是评估随访期间进行的二次血管内手术对危重肢体威胁缺血(CLTI)患者原位隐静脉细静脉搭桥术的通畅和肢体保留的影响。方法:2018年1月至2019年12月,43个中心的541例患者被纳入LIMBSAVE登记处(采用原位隐静脉技术治疗下肢缺血)。所有患者在1、3、6、9、12、18、24个月时都进行了严格的双相扫描监测。在随访期间,血管内手术的适应症是吻合口狭窄,改善磨合(髂狭窄)或磨合(胫骨血管狭窄或闭塞)。通过生命表分析(Kaplan-Meier检验)对总体通畅和肢体保留方面的两年估计结果进行分析。通过Gehan-Breslow-Wilcoxon检验,将接受血管内手术的患者(Group-endo)与随访期间未接受二次血管内手术的患者(Group-no endo)的结果进行比较。结果:两组在人口统计学和手术细节方面是相同的。总体平均随访时间为12.1个月(范围1-24个月)。在随访期间(>30天),49例患者(9.1%)接受了55例血管内手术(Group-endo)。大多数血管内手术(37/55,67.3%)用于治疗近端或远端吻合口狭窄。继发性血管内手术(40/55,72.7%)主要在首次手术后6个月内进行。估计2年总通畅率(97.9%比85.2%,P=0.05)和肢体保留率(100%比93.9%,P=0.05)在Group-endo组明显更好。结论:CLTI患者行隐静脉短段内旁路术后,二期血管内手术可显著提高中期整体通畅率和肢体保留率。
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来源期刊
CiteScore
2.50
自引率
7.10%
发文量
204
审稿时长
4-8 weeks
期刊介绍: The Journal of Cardiovascular Surgery publishes scientific papers on cardiac, thoracic and vascular surgery. Manuscripts may be submitted in the form of editorials, original articles, review articles, case reports, therapeutical notes, special articles and letters to the Editor. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (www.icmje.org). Articles not conforming to international standards will not be considered for acceptance.
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