Reserch In Early Detection Means And Risk Factors Of Restenosis After Bypass Grafting On Peripheral Artery Disease

Objective:1,To study the risk factors of restenosis after artificially graft bypass on chronic ischemia of lower extremities.2,To provide theorical foundation for early intervening and preventing restenosis after graft bypss.3,To define the early detection means and screening items of graft restenosis after graft bypass on peripheral arteriosclerotic disease.4,To establish the follow-up database of peripheral arteriosclerotic disease.Method:1,By the way of"Beijing University People's hospital clinical record system"to establish database of peripheral artery disease. To follow up the patients treated by graft bypss. The follow-up datas are statistically compared and the short- mid- long-term patency rate,limb salvage and mortality of four kinds of bypass operation are calculated.. A single center database are reported.2,40 cases treated with femoropopliteal bypass were followed up. All of patients filled in follow-up tables and made body examination. Basing on the degree of restenosis in vascular anastomosis by Color Doppler graft scan, we devided the cases into light, moderate and severe group, respectively. Ankle branchial index and pulse wave velocity through vascular function detecting instrument were examinated. Biochemical indictors and cytokines were investigated such as lipid, Fibronogen, hypersensitive C reactive protein, Interlukin-6, transforming growing factor beta1,et al. Possible risk factors resulting in restenosis were compared statistically among three groups.Results:1,There were 212 cases treated with bypass grafting during past 5 years. 1-year primary patency rate of aortoiliac bypass(AI), femorofemoral bypass(FF), femoropopliteal artery bypass to above-knee popliteal (FP-ak) and femoropopliteal artery bypass to below-knee popliteal (FP-bk) were 92%,76.9%,69.7% and 53.5%, respectively. After graft revision, 1-year secondary cumulative patency rate of AI, FF,FP-ak and FP-bk were 92%,84.6%,81.6%,60.5%, respectively. 3- year primary patency rate of AI, FF,FP-ak and FP-bk were 76.5%,62.5%,56.3%,23.8%, respectively. secondary cumulative patency rate were 82.4%,75%,70.8%,42.9%, respectively. FP-ak provided significant higher long-term patency and life expectancy than FP-bk(P<0.05). There were no significant difference in graft patency rate between AI and FF(P>0.05). During follow-up period, reoperation were performed in 52 cases. Among them, 42 cases(80.8%) were due to restenosis of vascular anastomosis resulting from intimal hyperplasia. 23 cases of the 212 operated limbs were subsequently lost by crural or femoral amputation(limb salvage 89.2%). The perioperative mortality rate(1 to 30 days) was 4.7% (10 cases). A further 23 cases died during follow up. Most of them(21 cases, 68.4%) died of cardiocerebral disease.2,Low-flow grafts(PSV<0.4m/s) occluded more frequently than higher-flow grafts(50% VS 10.7%, P<0.01). ABI of three groups in six months after operation were 0.91±0.17,0.89±0.16,0.52±0.24, respectively,decreasing by 0.08±0.07,0.12±0.06, 0.38±0.14 compared with baseline ABI in two week after operation. Decline range of ABI in severe group was significantly higher than light and moderate groups(P<0.05)。Pulse wave velocity(PWV) of three groups in follow-up period were 23.1±5.9m/s,26.7±6.7 m/s,9.5±7.3 m/s,PWV of severe group was significantly lower than the other two groups(P<0.05)。There were no statistic difference in ABI or PWV between LR and MR.3,Two weeks and six months after operation FIB, hsCRP,LDL,IL-6 and TGF-β1 were significantly higher in the SR group than other two groups(P<0.05). We compared those factors using multiple linear regression and find out that FIB and TGF-β1 may be risk factors which are related to intimal hyperplasia.Conclusions:1,A satisfactory result can be obtained in most patients if the appropriate surgery is choised for chronic limb ischemia. The mid- to long-term patency rate of FP-ak is higher than that of FP-bk.. The main reasons for restenosis after operation is neointima hyperplasia in vascular anastomosis. Cardiocerebral disease is the main reason for death of patients which suffer from peripheral artery disease after graft bypss.2,Graft survilence by duplux scan after bypass operation can early identify the restenosis lesions. ABI and PWV are not sensitive to identify the early restenosis of anastomosis. Higher levels of FIB, HsCRP, TGF-β1 may be the major high risk factors resulting in neointima hyperplasia of anastomotic restenosis.