| ObjectiveTo investigate the risk factors of graft stenosis or occlusion after femoralpopliteal artery bypass grafting,to improve the long-term graft patency and the clinical symptoms of LEAOD patients.Materials and MethodThe clinical data of patients with vascular surgery and femoral-popliteal artery bypass grafting(single / bilateral)were collected from March 2014 to March 2017 with the diagnosis of LEAOD.The date of patients' basic information,clinical manifestations,inflow / outflow tract conditions,as well as postoperative graft or other indicators of patency was recorded in detail.There were 46 patients and 52 limbs,including 35 males(76.09%)and 11 females(23.91%),and the average age was 69.42 ± 7.43 years old.Single / bilateral limbs were 40/6 cases,followed up for 6-36 months(mean 24.42 ± 11.28 months).All of the above patients were treated with femoral-popliteal artery grafting(ePTFE)bypass.The patients were divided into occlusion group(complete occlusion or stenosis rate?70%)and unobstructed group(narrowing rate <70%)according to the results of ultrasonography.SPSS 17.0 statistical software was used to analyze the results;The categorical variables were analyzed by x2 test;The Log-Rank test was used to compare the cumulative patency rates after operation;Life-Table method and Kaplan-Meier method were used to analyze the cumulative patency rate;Cox multivariate analysis was used to analyze the various risk factors leading to postoperative graft occlusion,P <0.05 represents the difference was statistically significant.Result(1)Cox multivariate analysis showed that there was significant difference(P <0.05)in the postoperative cumulative patency rate of vascular grafts,in diabetes mellitus,hyperlipidemia,only one distal outflow tract patency and smoking(2)There were no significant differences in the contrast of two groups' diabetes,hyperlipidemia and preoperative only one outflow tract patency under the knee in the postoperative 6,12,24 months.(P >0.05),but there were significant differences in the above factors at 36 months(P <0.05).However,the smoking factors were significantly different between the two groups during the whole observation period(P <0.05)(3)The effect of tobacco application on postoperative graft occlusion:Kaplan-Meier method was used to compare the effects of smoking in both groups;The postoperative patency time of grafts were 19.087 and 30.393 months;The difference between the two groups was significant(P <0.05);Further research could confirm:the postoperative patency time of the grafts in the quit smoking group and the non-smoking group were 29.948,20.894(month);The difference between the two groups was significant(P <0.05)(4)The effect of hyperlipidemia on postoperative graft occlusion:the Kaplan-Meier method was used to compare the differences between groups with hyperlipidemia,normal blood lipids,LDLP<100mg/dl,LDLP? 100mg/dl,HDL<40mg/dl,HDL?40mg/dl;The postoperative patency time of the grafts were 21.049,27.135,30.528,19.458,19.094,32.847 months,There was significant difference between the two groups(P <0.05)Conclusion1.Diabetes mellitus,hyperlipidemia,smoking,and Only one of the vascular outflow tract was unobstructed preoperative under the knee were important risk factors of graft occlusion after artificial vascular bypass surgery in femoral popliteal arteries2.Diabetes mellitus,hyperlipidemia and only one outflow tract vascular patency under the knee before surgery were the risk factors of late occlusion of femoral-popliteal artery bypass,while smoking could affect the whole process of disease development 3.Postoperative smoking cessation and the control of blood lipid(LDL-C< 100ml/dl,HDL-C?40mg/dl)could improve graft patency rate... |
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