老年人下肢动脉闭塞的血管重建术262例分析

Revascularization of lower limb artery ischemia for elder patients

目的总结对下肢缺血老年患者进行动脉重建术的手术效果及影响预后的因素。方法回顾性分析从2006年1月至2008年11月收治的262例下肢动脉缺血的老年患者的临床资料。总结对老年患者行下肢动脉重建术围手术期的关注要点及影响远期预后的因素。结果本组262例老年患者（323条患肢），下肢动脉血管旁路术102条，腔内治疗98条，单纯取栓／内膜剥脱术67条，手术（血管搭桥／取栓／内膜剥脱术）结合腔内治疗多节段病变56条。手术成功率94．7％，围手术期死亡2例（30d内），围手术期严重并发症15例。262例中245例患者获得术后获有效随访，随防率93．5％，随访时间1—35个月，平均（18±10）个月。随访期内，死亡15例，血管I期通畅率80．5％，Ⅱ期通畅率92．7％，保肢率95．2％。危险因素分析提示：有冠心病病史和年龄大于70岁的病例组在随访期内死亡明显高于其他组。合并糖尿病、病情严重、病变范围广导致术后血管再闭塞发生率高，且截肢数量增加。结论重症下肢动脉闭塞症的动脉重建术依赖于熟练的手术经验，综合性的多科室协作，合理的手术方案以及围手术期的细致管理。

Objective To evaluate the result of revascularization for lower limb artery ischemia in elder patients. Method During Jan 2006 to Nov 2008, 262 elder patients （60 years old and up）, underwent artery revascularization for lower limb arterial ischemia. Mortality, morbidity, primary pateney, secondary patency and limb salvage were analyzed. Result There were a total of 323 ischemia limbs in those 262 elder patients undergoing revascularization, among those 102 limbs underwent artery bypass, 98 limbs underwent endoluminal angioplasty with or without stenting, 67 limbs underwent embolectomy or endarterectomy, 56 limbs underwent open surgery combined with endoluminal treatment due to multiple segment lesions. Operation success rate was 94. 7%. Two patients died within 30 days. Perioperative morbidity developed in 15 cases. 245 patients （93.5%） were followed-up from 1 month to 35 months. Mortality was 6. 1% （ 15 cases） , primary patency was 80. 5% , secondary patency was 92. 7% and limb salvage rate was 95.2%. Risk factors analysis showed that history of cardiac disease and elder ages were associated with higher mortality. Diabetes mellitus, critical ischemia and multiple segment lesions were associated with poor long term patency and limb salvage. Conclusion Lower limb ischemia is severe disease related to elder patients＇ death and amputation. Careful patient selection, detailed pre-operation work-up, meticulous operative technique play crucial roles for a successful arterial reconstruction.