Explore The Relative Factors Of Restenosis And Occlusion After Artificially Grafting Femoropopliteal Bypass

Objective:To explore the relative clinical risk factors of restenosis and occlusion after artificially grafting femoropopliteal bypass on chronic ischemia of low extremities in different postoperation time. To understand the clinical significance of controlling the risk factors during the perioperation time, and hope to improve the long-term patency rate of artificial blood vessels, improving the treatment of patients with lower limb arteriosclerosis obliterans.Material and methods:From May2007to June2011,97consecutive patients (115limbs) who registered in the Department of Vascular Surgery of Tianjin Union Medicine Center with a clinical diagnosis of arteriosclerosis obliteran, received artificially grafting femoropopliteal bypass. All clinical, perioperative and follow-up data were obtained. All patients were divided into occlusive group and patent group according to their grafting patency in different postoperation time. Statistical analysis using SPSS16.0software, the use of multiple risk factors analysis, life table, independent sample t-test data, categorical variable data γ2test statistical methods, determining the risk factors associated with the artificial vascular occlusion by analyzing the general situation for patients, preoperative complications, postoperative smoking cessation and lipid control situation.Results:(1) All limbs cumulative patency average time was41.02(month),6months,1year,2years,3years,4-year cumulative patency rates were78%,69%,62%,53%and42%.(2) Cox proportional hazards analysis indicated that diabetes, smoking history and only one run-off artery which wasn’t serious stenosis or occlusive were the risk factor associated with the artificial vascular occlusion, P values were less than0.05.(3) Compared risk factors in the different postoperative period, we found that there were no significant difference in constituent ratio of hypertension, cerebral infarction, coronary heart disease, diabetes, hyperlipidemia and run-off way in the occlusion group and the unobstructed group after6months and12months operatiaon. Diabetes mellitus were significantly higher in the occlusive group at24months (57.1%, P<0.05). The rates of the patients who had only one run-off artery which wasn’t serious stenosis or occlusive were50%in occlusive group and were29.8%in patent group. There were significant difference between2groups (P<0.05). The rates of the patients who had smoking history significantly higher in the occlusive group. There were significant difference between2groups (P<0.05).(4) The impact of smoking on the patency rate: The average cumulative patency time of artificial blood vessels of patients who had no smoking history is42.764months, and the average cumulative patency time of artificial blood vessels of patients who had smoking history is42.764months. Using the Log-Rank test, There were significant difference in the average cumulative patency time between2groups (P<0.05). The cumulative patency rate of artificial blood vessels of patients who had smoking history was lower than patients who had no smoking historyThe average cumulative patency time of artificial blood vessels of patients who were successed in smoking cessation was32.593months, and the average cumulative patency time of artificial blood vessels of patients who were failed in smoking cessation was42.764months. Using the Log-Rank test, There were significant difference in the average cumulative patency time between2groups (P<0.05). The cumulative patency rate of artificial blood vessels of patients who were successes in smoking cessation was higher than patients who were failed in smoking cessation.(5) The impact of hyperlipidemia on the patency rate:The average cumulative patency time of artificial blood vessels of patients with hyperlipidemias is35.287months, and the average cumulative patency time of artificial blood vessels of patients with normal lipid is36.180months. Using the Log-Rank test, There were no significant difference in the average cumulative patency time between2groups (P<0.05).The average cumulative patency time of artificial blood vessels of patients who’s LDLP<100mg/dl was42.034months during the postoperative time, and the average cumulative patency time of artificial blood vessels of patients who’s LDLP>100mg/dl was23.277months during the postoperative time. Using the Log-Rank test, There were significant difference in the average cumulative patency time between2groups (P<0.05). The cumulative patency rate of artificial blood vessels of patients who’s LDLP<100mg/dl was higher than patients who’s LDLP>100mg/dl was23.277months during the postoperative time.Conclusion:1.diabetes, smoking history or only one run-off artery which wasn’t serious stenosis or occlusive as a significant risk factors was identified for the cumulative patency failure.2outflow tracts and diabetes effect long-term primary patency after artificially grafting femoropopliteal bypass, but it have limited effect on short-term primary patency.3smoking affects both short-term and long-term patency after artificially grafting femoropopliteal bypass.4smoking cessation and control of blood lipids (the LDLP<100mg/dl) can improve the patency rate of the artificial blood vessels during the postoperative period.