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KMID : 0357019960120020181
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Journal of the Korean Vascular Surgery Society
1996 Volume.12 No. 2 p.181 ~ p.189
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Infrainguinal Arterial Reconstructions for Chronic Lower Limb Ischemia
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조병선
김민영/윤익진/하종원/김상준
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Abstract
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Chronic lower extremity ischemia causes debilitating ischemic pain and results in a functional limb loss and impairs the quality of life. To elucidate overall aspects of the peripheral vascular reconstructions including patency rate, choice of
graft
materials and risk factors for the patency, we analyzed 187 infrainguinal reconstructions from Jan. 1986 to May. 1996. Graft patency was determined by Kaplan-Meier method and comparison between the variables was determined by Log-Rank test. Mean
age of
the patients was 49 years (ASO:62, TAO :38) and 162 were men and 6 were women. Mean follow-up period was 31 months. The etiologies were ASO in 97, TAO in 78 and others in 11. Associated diseases in ASO were DM in 19(19.6%), hypertension in
31(32%)
and
cardiac disease in 32(33%) Mean preoperative ABI was 0.34. In ASO, 35(36.1%) bypasses were performed for claudication, 40(41.2%) for resting pain, 22(22.7)% for impending tissue loss and in TAO, 17(21.8%), 24(30.8%), and 37(47.4%) respectively.
Femoropopliteal bypass were performed in 57, femorodistal in 79. Inflow procedures were performed in 30. Autogenous vein was used in 157, prosthetic graft in 26, and composite in 4. Postoperative complications developed in 31(16.6%) but no
mortality.
Overall 1, 2, 3, 4, 5-year primary and secondary patency rates were 83.7%, 82.7%, 77.4%, 71.2%, 67.8% and 89.4%, 85.7%, 90.1%, 75.8%, 67.8%, respectively. The early patency rate of ASO was higher than TAO(p=0.002) but late patency rate was
similar
in
TAO and ASO.
In ASO, whatever the graft material was, the patency rate were not different, however, in TAO, improved patency was resulted from use of the autogenous veins. Major risk factors such as DM, smoking and preoperative ABI did not influence on the
graft
patency. Graft failure occurred in 40 cases(21.4%). Of these, 29 occlusions occurred within 1 year. We conclude that successful vascular reconstructions can be achieved by careful selection of distal anastomotic site, use of autogenous veins and
proper
correction of inflow lesions for chronic ischemia of lower extremity.
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KEYWORD
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