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Ergebnisse der peripheren Bypasschirurgie bei Patienten mit kritischer Extremitätenischämie

CRITISCH-Register

Results of peripheral bypass surgery in patients with critical limb ischemia

CRITISCH registry

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The Originalien to this article was published on 13 July 2016

Zusammenfassung

Zielsetzung

Die Ergebnisse der peripheren Bypasschirurgie in Abhängigkeit von der Lokalisation des distalen Anschlusses und von der Art des Bypassmaterials werden anhand der Daten des CRITISCH-Registers bei Patienten mit kritischer Extremitätenischämie (CLI) dargestellt.

Patienten und Methodik

284 CLI-Patienten mit peripherem Bypass (75 Patienten mit Bypässen oberhalb des Knies [Gruppe 1], 80 Patienten mit Bypässen unterhalb des Knies [Gruppe 2] und 129 krurale/pedale Bypässe [Gruppe 3]) wurden analysiert. 159 Venenbypässen standen 125 Kunststoffbypässe gegenüber.

Ergebnisse

Im Gesamtkrankengut verlief der Eingriff bei 191 von 284 Patienten (67,3 %) ohne Komplikationen, bei 236 von 284 (83,1 %) Patienten war der Bypass bei Entlassung offen. 76 % der Patienten der Gruppe 1, 62,5 % in Gruppe 2 und 65,1 % in Gruppe 3 zeigten einen komplikationslosen postoperativen Verlauf. Das amputationsfreie Überleben lag nach 1 Jahr bei 86 % in Gruppe 1, 65 % in Gruppe 2 und 69 % in Gruppe 3. Bei Bypässen oberhalb des Kniegelenks war Kunststoffmaterial dem Venenbypass zumindest nicht unterlegen (amputationsfreies Überleben nach 1 Jahr Kunststoffbypass 92 %, Venenbypass 71 %, p = 0,147), während umgekehrt in der Gruppe der kruralen/pedalen Bypässe Venenbypässe mit 76 % ein besseres amputationsfreies Überleben nach 1 Jahr zeigten als Kunststoffbypässe mit 56 % (p = 0,105). Patienten mit einem PIII-CLI-Risikoscore ≤ 3 wiesen mit 78 % ein besseres amputationsfreies Überleben nach 1 Jahr auf als Patienten mit PIII-CLI-Risikoscore 4–7 (69 %, p = 0,053). Das Gleiche galt für Patienten mit Rutherford-Klasse 4 vs. Rutherford-Klasse 6.

Schlussfolgerungen

Bei Patienten mit CLI im Follow-up über 1 Jahr bietet die Vene bei Bypässen mit Anschlüssen oberhalb des Knies keine Vorteile gegenüber Kunststoff, wohl aber bei weiter distal gelegenen Anastomosen.

Abstract

Aim

The outcomes of patients with critical limb ischemia (CLI) who underwent lower extremity bypass surgery were analyzed based on the data in the CRITISCH registry with respect to the localization of the distal anastomosis and type of bypass material.

Patients and methods

In total 284 patients with a lower extremity bypass (group 1: 75 patients with bypass above the knee, group 2: 80 patients with bypass below the knee and group 3: 129 patients with crural or pedal bypass) were included in this study. The graft material included 159 autologous saphenous vein grafts and 125 prosthetic grafts.

Results

There were no perioperative complications in 191 out of the 284 patients (67.3 %) and in 236 out of the 284 (83.1 %) patients the bypass remained open at discharge from hospital. An uneventful postoperative course was documented in 76 % of the patients in group 1, 62.5 % in group 2 and 65.1 % in group 3. The amputation-free survival at 1 year was 86 % in group 1, 65 % in group 2 and 69 % in group 3. In patients with a bypass above the knee prosthetic grafts were at least not inferior to vein grafts (amputation-free survival at 1 year: prosthetic bypasses 92 %, saphenous vein grafts 71 %, p = 0.147), while in the group with a crural or pedal bypass, vein grafts showed a better amputation-free survival at 1 year (76 %) compared with prosthetic bypasses (56 %, p = 0.105). Patients with a PIII CLI risk score ≤ 3 exhibited a better amputation-free survival at 1 year of 78 % compared to patients with PIII CLI risk scores 4–7 with 69 % (p = 0.053). The same applied to patients with Rutherford stage 4 versus Rutherford stage 6 CLI.

Conclusions

In patients with CLI and a bypass above the knee, vein grafts provide no benefits for at least 1 year follow-up when compared with prosthetic grafts. But in more distal anastomoses vein grafts should be preferred.

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Correspondence to R. T. Grundmann.

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Interessenkonflikt

T. Bisdas, G. Torsello, A. Stachmann, R. T. Grundmann und die CRITISCH-Studiengruppe geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Additional information

CRITISCH-Studiengruppe: Adili F, Balzer K, Betz T, Billing A, Bisdas T, Böckler D, Brixner D, Debus SE, Donas KP, Eckstein HH, Florek HJ, Gkremoutis A, Hupp T, Keck T, Gerß J, Grundmann RT, Klonek W, Lang W, Ludwig U, May B, Meyer A, Mühling B, Oberhuber A, Reinecke H, Reinhold C, Ritter RG, Schelzig H, Schlensack C, Schmitz-Rixen T, Schulte KL, Spohn M, Stachmann A, Stavroulakis K, Steinbauer M, Storck M, Torsello G, Trede M, Weis-Müller B, Wenk H, Zeller T, Zimmermann A.

Mit Unterstützung des DIGG der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG).

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Bisdas, T., Torsello, G., Stachmann, A. et al. Ergebnisse der peripheren Bypasschirurgie bei Patienten mit kritischer Extremitätenischämie. Gefässchirurgie 21, 96–104 (2016). https://doi.org/10.1007/s00772-016-0116-z

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  • DOI: https://doi.org/10.1007/s00772-016-0116-z

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