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首页> 外文期刊>Hong Kong medical journal =: Xianggang yi xue za zhi >Bypass surgery or percutaneous transluminal angioplasty to treat critical lower limb ischaemia due to infrainguinal arterial occlusive disease?
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Bypass surgery or percutaneous transluminal angioplasty to treat critical lower limb ischaemia due to infrainguinal arterial occlusive disease?

机译：旁路手术或经皮腔内血管成形术，由于盲目的动脉闭塞疾病，治疗临界下肢缺血性？

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OBJECTIVES: To define the role of bypass surgery and percutaneous transluminal angioplasty to manage critical limb ischaemia due to infrainguinal arterial occlusive disease. DESIGN: Retrospective review. SETTING: Regional hospital, Hong Kong. PATIENTS: Consecutive patients treated for critical limb ischaemia, for whom data were prospectively collected in those who underwent: (i) infrainguinal percutaneous transluminal angioplasty first, or (ii) infrainguinal bypass surgery. RESULTS: Among patients with critical lower limb ischaemia, 364 consecutive individuals having infrainguinal bypass operations and 100 having percutaneous transluminal angioplasty first were compared. The latter patients were older (77 vs 74 years, P=0.014) and had more co-morbidities but higher ankle pressure than those having bypass surgery. In the angioplasty-first group, 74% had favourable lesions (classified as TransAtlantic Inter-Society Consensus A/B). In the bypass group, operative mortality was higher (4% vs 1%, P=0.03) than that in the angioplasty-first group. Hospital mortality was comparable (8% vs 3%, P=0.15). In the bypass group, median hospital stay was longer than that in the angioplasty-first group (24 vs 4 days, P<0.001), and postoperatively they also had a higher median ankle-brachial index (0.92 vs 0.70, P<0.001) and superior long-term patency. In the bypass group, American Society of Anesthesiologists class 4 patients suffered very high operative and hospital mortality (15% and 31%, respectively). Long-term patency of percutaneous transluminal angioplasty depended on the TransAtlantic Inter-Society Consensus class of the treated lesion. Limb salvage rates at 3 years were 89% and 78% for percutaneous transluminal angioplasty first and surgical bypass, respectively (P=0.046). Long-term survival was poorer in the percutaneous transluminal angioplasty-first group (21% vs 51% at 5 years, P=0.04). CONCLUSION: Infrainguinal bypass and percutaneous transluminal angioplasty are complementary. For TransAtlantic Inter-Society Consensus A and B lesions, percutaneous transluminal angioplasty should be offered first. For American Society of Anesthesiologists class 4 patients, percutaneous transluminal angioplasty should be considered first, regardless of the TransAtlantic Inter-Society Consensus class.
机译：目的：以旁路手术和经皮腔内血管成形术的作用，以造林动脉闭塞疾病导致管理临界肢体缺血。设计：回顾性评论。环境：香港地区医院。患者：治疗临界肢体患者的连续患者，对其进行预期的数据，在那些（i）前瞻性分子血管成形术第一，或（ii）前瞻性手术中进行数据。结果：临界下肢患者中，比较了364名患有患者旁路操作的364个，患有经皮腔内血管成形术的100个具有经皮腔内血管成形术。后者患者年龄较大（77 vs 74岁，P = 0.014），并且具有比旁路手术的脚踝压力更高。在血管成形术 - 第一组中，74％有良好的病变（归类为跨大西洋社会间共识A / B）。在旁路组中，术治疗死亡率较高（4％vs1％，p = 0.03）。医院死亡率相当（8％vs 3％，p = 0.15）。在旁路集团中，中位医院住宿比血管成形术 - 第一组（24 vs 4天，P <0.001），术后还有一个更高的中位数脚踝 - 臂臂指数（0.92 Vs 0.70，P <0.001）和卓越的长期通畅。在旁路集团中，美国麻醉师学会4名患者患有非常高的手术和医院死亡率（分别为15％和31％）。经皮腔内血管成形术的长期通畅取决于跨大西洋社会间共识类的治疗病变。肢体血管成形术第一和外科旁路分别为3年的肢体救生率为89％和78％（P = 0.046）。长期存活率在经皮腔成形术 - 第一组（5年5岁51％，P = 0.04）。结论：侵略性旁路和经皮腔内血管成形术是互补的。对于跨大西洋社会间共有A和B病变，首先应提供经皮腔内血管成形术。对于美国麻醉学士学家4级患者，无论跨大西洋间共识课程如何，应首先考虑经皮腔内血管成形术。

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