内镜下静脉采集与腹股沟下旁路手术的预后较差但有所改善。

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Journal of Vascular Surgery Pub Date : 2024-12-30 DOI:10.1016/j.jvs.2024.12.126
Mohamad Chahrour, Hassan Chamseddine, Alexander Shepard, Timothy Nypaver, Mitchell Weaver, Tamer Boules, Jamal J Hoballah, Maen Aboul Hosn, Loay Kabbani
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引用次数: 0

摘要

目的:大隐静脉采集技术对腹股沟下搭桥结果的影响仍然是一个有争议的问题,没有强有力的证据表明某一特定技术优于其他技术。本研究的目的是比较腹股沟下搭桥手术患者开放静脉采集与内镜下静脉采集的结果。方法:在2011年至2023年期间,使用单段大隐静脉从股起始点行腹股沟下旁路手术的患者在血管质量倡议腹股沟下旁路模块中被识别。仅包括因外周动脉疾病行旁路手术的患者,不包括原位旁路手术的患者。然后根据患者的静脉采集技术分为开放静脉采集组和内镜静脉采集组。进行三对一的不替换的最近邻倾向评分匹配,以确保两个比较组之间协变量的平衡。Kaplan-Meier和cox -回归分析用于估计长期事件发生率,并评估静脉采伐技术与原发性通畅、原发性辅助通畅、继发性通畅、再干预、截肢和主要肢体不良事件(定义为截肢和/或再干预的复合结果)的关系。结果:7,929例接受开放静脉采集的患者与2,643例接受内镜静脉采集的患者相匹配。在倾向评分匹配后,平衡了所有基线特征、人口统计学特征和手术细节。内镜下静脉采收术的手术部位感染率明显低于对照组(1.8% vs 2.9%, p=0.003),而其他围手术期结局包括移植物感染(p=0.12)、心肌梗死(p=0.16)、卒中(p=0.13)和返回手术室(0.14)在两组之间相似。在1年的随访中,开放静脉采收患者的原发性通畅率显著提高(71% vs 65%)。结论:虽然内镜下静脉采收与较低的术后伤口并发症发生率相关,但在研究期间,开放静脉采收在通畅、再干预和肢体保留方面具有优越的长期结果。尽管如此,内窥镜静脉采收多年来已经证明了原发性通畅的改善,显着缩小了两种采收方法之间的差距。
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Endoscopic vein harvest is associated with worse but improving outcomes in infrainguinal bypass.

Objective: The impact of great saphenous vein harvest technique on infrainguinal bypass outcomes remains a matter of debate, with no robust evidence favoring a specific technique over the other. This study aims to compare the outcomes of open vein harvest (OVH) with endoscopic vein harvest (EVH) in patients undergoing infrainguinal bypass surgery.

Methods: Patients who underwent an infrainguinal bypass from a femoral origin using a single-segment great saphenous vein between 2011 and 2023 were identified in the Vascular Quality Initiative infrainguinal bypass module. Only patients undergoing a bypass for peripheral artery disease were included, and those undergoing in-situ bypass were excluded. Patients were then classified according to their vein harvest technique into OVH and EVH groups. Three-to-one nearest-neighbor propensity score matching without replacement was performed to ensure balance of covariates between the two comparison groups. Kaplan-Meier and Cox regression analysis were used to estimate long-term event rates and evaluate the association of vein harvest technique with the primary outcomes of primary patency, primary-assisted patency, secondary patency, reintervention, amputation, and major adverse limb events, defined as the composite outcome of amputation and/or reintervention.

Results: A total of 7929 patients who underwent OVH were matched to 2643 patients who underwent EVH. All baseline characteristics, demographics, and operative details were balanced after propensity score matching. EVH had a significantly lower rate of surgical site infections (1.8% vs 2.9%; P = .003), whereas other perioperative outcomes, including graft infection (P = .12), myocardial infarction (P = .16), stroke (P = .13), and return to operating room (P = .14) were similar between the two groups. At 1-year follow-up, OVH patients had a significantly higher primary patency (71% vs 65%; P < .001), primary-assisted patency (86% vs 81%; P < .001), and secondary patency (90% vs 85%; P < .001), and significantly lower rates of amputation (6% vs 9%; P < .001), reintervention (20% vs 25%; P < .001), and major adverse limb events (25% vs 30%; P < .001) compared with EVH patients. The primary patency of EVH bypasses significantly increased from 59% to 70% between 2011 and 2020 (P = .042). Although OVH had a significantly higher primary patency compared with EVH in 2011 to 2012 (72% vs 59%; P = .006), this difference diminished over time, with no significant difference observed in the most recent interval (2019-2020) studied (73% vs 70%; P = .214).

Conclusions: Although EVH is associated with a lower postoperative wound complication rate, OVH conferred superior long-term outcomes of patency, reintervention, and limb salvage over the study period. Nonetheless, EVH has demonstrated improvements in primary patency over the years, significantly narrowing the gap in this outcome between the two harvest methods.

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来源期刊
CiteScore
7.70
自引率
18.60%
发文量
1469
审稿时长
54 days
期刊介绍: Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.
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