Analiza faktora rizika od okluzije sintetskog grafta kod femoropoplitealnog bajpasa
Sažetak
Uvod/Cilj. Femoropoplitealni (FP) bajpas je revaskularizaciona tehnika donjih ekstremiteta sa odličnim ishodom. Velika vena safena najbolji je materijal za graft, ali ako nije adekvatna ili je uklonjena, sintetički graftovi su korisna alternativa. Najznačajnija komplikacija sa ozbiljnijim posledicama je okluzija grafta. Cilj rada bio je da se analiziraju faktori za okluziju sintetičkog grafta kod FP bajpasa. Metode. Ova retrospektivna studija tipa slučaj-kontrola obuhvatila je sve bolesnike kod kojih je urađen FP bajpas sintetskim graftom zbog arterijske bolesti donjih ekstremiteta u Centru za vaskularnu hirurgiju Kliničkog centra u Kragujevcu od 2007. do 2013. godine. Grupu slučajeva činili su bolesnici sa okluzijom femoropoplitealnog bajpasa (n = 44), a kontrolnu grupu činili su bolesnici bez takvog ishoda (n = 88). Rezultati. Značajan uticaj na okluziju imali su prateća kardiovaskularna oboljenja (adjustedOR 27,05; 95% CI 4,74; 154,35), vrsta femoropoplitealnog bajpasa (adjustedOR 16,50; 95% CI 4,05; 67,24), prethodna vaskularna intervencija (adjustedOR 4,67; 95% CI 1,20; 18,14), klinički stadijum bolesti (adjustedOR 3,73; 95% CI 1,94; 7,18), davanje postoperativne antikoagulantne terapije (adjustedOR 0,05; 95% CI 0,01; 0,23) i korišćenje inhibitora angiotenzin konvertujućeg enzima (adjustedOR 0,14; 95% CI 0,03; 0,70). Značajan zajednički uticaj imale su sledeće kombinacije posmatranih faktora rizika: tip femoropoplitealnog bajpasa i kardiovaskularnih oboljenja, tip femoropoplitealnog bajpasa i prethodnih vaskularnih postupaka, prethodnih vaskularnih postupaka i kardiovaskularnih oboljenja, prethodnih vaskularnih postupaka i upotrebe beta blokatora, kardiovaskularnih oboljenja i dijabetesa, tip femoropoplitealnog bajpasa i antiagregacione terapije, kliničkog stadijuma bolesti i kardiovaskularnih oboljenja, prethodnih vaskularnih postupaka i antiagregacione terapije. Zaključak. Prateća kardiovaskularna oboljenja, potkoleni femoropoplitealni bajpas, uznapredovali stadijum vaskularne bolesti i nekorišćenje antikoagulantne terapije i inhibitora angiotenzin-konvertujućeg enzima značajni su prediktori okluzije grafta nakon sintetskog femororpoplitealnog bajpasa. Zajednički uticaj ukazuje i na značaj dijabetesa, upotrebe beta blokatora i trombocitne antiagregacione terapije
Reference
Takagi H, Goto S, Matsui M, Manabe H, Umemoto T. A contem-porary meta-analysis of Dacron versus polytetrafluoroethylene grafts for femoropopliteal bypass grafting. J Vasc Surg 2010; 52(1): 232−6.
Debus ES, Larena-Avellaneda A, Heimlich F, Goertz J, Fein M. Al-loplastic bypass material below the knee: actual rationale. J Cardiovasc Surg (Torino) 2013; 54(Suppl 1): 159−66.
Dohmen A, Eder S, Euringer W, Zeller T, Beyersdorf F. Chronic critical limb ischemia. Dtsch Arztebl Int 2012; 109(6): 95−101.
Baldwin ZK, Pearce BJ, Curi MA, Desai TR, McKinsey JF, Bassiouny HS, et al. Limb salvage after infrainguinal bypass graft failure. J Vasc Surg 2004; 39(5): 951−7.
Goodney PP, Nolan BW, Schanzer A, Eldrup-Jorgensen J, Bertges DJ, Stanley AC, et al. Factors associated with amputation or graft occlusion one year after lower extremity bypass in northern New England. Ann Vasc Surg 2010; 24(1): 57−68.
Pulli R, Dorigo W, Castelli P, Dorrucci V, Ferilli F, De BG, et al. Midterm results from a multicenter registry on the treatment of infrainguinal critical limb ischemia using a heparin-bonded ePTFE graft. J Vasc Surg 2010; 51(5): 1167−77.
Hertzer NR, Bena JF, Karafa MT. A personal experience with the influence of diabetes and other factors on the outcome of infrainguinal bypass grafts for occlusive disease. J Vasc Surg 2007; 46(2): 271−9.
Singh N, Sidawy AN, de Zee KJ, Neville RF, Akbari C, Henderson W. Factors associated with early failure of infrainguinal lower extremity arterial bypass. J Vasc Surg 2008; 47(3): 556−61.
Tangelder MJ, Algra A, Lawson JA, Eikelboom BC. Risk factors for occlusion of infrainguinal bypass grafts. Eur J Vasc Endovasc Surg 2000; 20(2): 118−24.
Alpagut U, Ugurlucan M, Banach M, Mikhailidis DP, Dayioglu E. Does gender influence the patency of infrainguinal bypass grafts. Angiology 2008; 59(3): 278−82.
Brumberg RS, Back MR, Armstrong PA, Cuthbertson D, Shames ML, Johnson BL, et al. The relative importance of graft surveillance and warfarin therapy in infrainguinal prosthetic bypass failure. J Vasc Surg 2007; 46(6): 1160−6.
Lancaster RT, Conrad MF, Patel VI, Cambria RP, LaMuraglia GM. Predictors of early graft failure after infrainguinal bypass surgery: a risk-adjusted analysis from the NSQIP. Eur J Vasc Endovasc Surg 2012; 43(5): 549−55.
Schanzer A, Hevelone N, Owens CD, Belkin M, Bandyk DF, Clowes AW, et al. Technical factors affecting autogenous vein graft failure: observations from a large multicenter trial. J Vasc Surg 2007; 46(6): 1180−90.
Bosiers M, Deloose K, Verbist J, Schroë H, Lauwers G, Lansink W, et al. Heparin-bonded expanded polytetrafluoroethylene vascular graft for femoropopliteal and femorocrural bypass grafting: 1-year results. J Vasc Surg 2006; 43(2): 313−8.
Nolan BW, de Martino RR, Stone DH, Schanzer A, Goodney PP, Walsh DW, et al. Prior failed ipsilateral percutaneous endovas-cular intervention in patients with critical limb ischemia pre-dicts poor outcome after lower extremity bypass. J Vasc Surg 2011; 54(3): 730−5.
Baril DT, Goodney PP, Robinson WP, Nolan BW, Stone DH, Li Y, et al. Prior contralateral amputation predicts worse outcomes for lower extremity bypasses performed in the intact limb. J Vasc Surg 2012; 56(2): 353−60.
Brown J, Lethaby A, Maxwell H, Wawrzyniak AJ, Prins MH. An-tiplatelet agents for preventing thrombosis after peripheral ar-terial bypass surgery. Cochrane Database Syst Rev 2008; 8(4): CD000535.
Henke PK, Blackburn S, Proctor MC, Stevens J, Mukherjee D, Ra-jagopalin S, et al. Patients undergoing infrainguinal bypass to treat atherosclerotic vascular disease are underprescribed car-dioprotective medications: effect on graft patency, limb sal-vage, and mortality. J Vasc Surg 2004; 39(2): 357−65.
Twine CP, Mclain AD. Graft type for femoro-popliteal bypass surgery. Cochrane Database Syst Rev 2010; 12(5): CD001487.
Jensen LP, Lepäntalo M, Fossdal JE, Røder OC, Jensen BS, Madsen MS, et al. Dacron or PTFE for above-knee FP bypass. a multi-center randomised study. Eur J Vasc Endovasc Surg 2007; 34(1): 44−9.
Van Det RJ, Vriens BH, van der Palen J, Geelkerken RH. Dacron or ePTFE for femoro-popliteal above-knee bypass grafting: short- and long-term results of a multicentre randomised trial. Eur J Vasc Endovasc Surg 2009; 37(4): 457−63.
Engelhardt M, Boos J, Bruijnen H, Wohlgemuth W, Willy C, Tann-heimer M, et al. Critical limb ischaemia: initial treatment and predictors of amputation-free survival. Eur J Vasc Endovasc Surg 2012; 43(1): 55−61.
Antoniou GA, Chalmers N, Georgiadis GS, Lazarides MK, Antoniou SA, Serracino-Inglott F, et al. A meta-analysis of endovascular versus surgical reconstruction of femoropopliteal arterial dis-ease. J Vasc Surg 2013; 57(1): 242−53.
Taylor SM, York JW, Cull DL, Kalbaugh CA, Cass AL, Langan EM. Clinical success using patient-oriented outcome measures after lower extremity bypass and endovascular intervention for ischemic tissue loss. J Vasc Surg 2009; 50(3): 534−41.
Söderström M, Arvela E, Aho PS, Lepäntalo M, Albäck A. High leg salvage rate after infrainguinal bypass surgery for ischemic tissue loss (Fontaine IV) is compromised by the short life ex-pectancy. Scand J Surg 2010; 99(4): 230−4.
Smeets L, Ho GH, Tangelder MJ, Algra A, Lawson JA, Eikelboom BC, et al. Outcome after occlusion of infrainguinal bypasses in the Dutch BOA Study: comparison of amputation rate in ve-nous and prosthetic grafts. Eur J Vasc Endovasc Surg 2005; 30(6): 604−9.
Jackson MR, Johnson WC, Williford WO, Valentine JR, Clagett PG. The effect of anticoagulation therapy and graft selection on the ischemic consequences of femoropopliteal bypass graft occlusion: results from a multicenter randomized clinical trial. J Vasc Surg 2002; 35(2): 292−8.
Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, re-nal, mesenteric, and abdominal aortic): executive summary a collaborative report. J Am Coll Cardiol 2006; 21(47): 1239−312.
Mohler E 3rd, Giri J; ACC; AHA. Management of peripheral arterial disease patients: comparing the ACC/AHA and TASC-II guidelines. Curr Med Res Opin 2008; 24(9): 2509−22.
Moxey PW, Hofman D, Hinchliffe RJ, Jones K, Thompson MM, Holt PJ. Trends and outcomes after surgical lower limb revasculari-zation in England. Br J Surg 2011; 98(10): 1373−82.
Inan B, Aydin U, Ugurlucan M, Aydin C, Teker ME. Surgical treatment of lower limb ischemia in diabetic patients - long-term results. Arch Med Sci 2013; 9(6): 1078−82.
Pulli R, Dorigo W, Guidotti A, Fargion A, Alessi IA, Pratesi C. The Role of Infrainguinal Bypass Surgery in the Endovascular Era. Ann Vasc Dis 2014; 7(1): 7−10.