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서혜부 하부 만성 동맥폐색 환자의 예후: 우회로 수술군과 비수술군의 예후

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Author(s)
김형태조원현이창수김홍
Alternative Author(s)
Kim, Hyoung TaeCho, Won HyunRhee, Chang SooKim, Hong
Publication Year
2002
Keyword
Infrainguinal arterial occlusionClaudicationAmputation서혜부 하부 동맥 폐색파행하지 절단
Abstract
Purpose: In order to evaluate the result of medical treatment and compare with surgical management in infrainguinal arterial occlusion, we analyzed 145 cases of infrainguinal chronic arterial occlusion that admitted our department during recent 5 years.
Method: Patients were grouped into 2 according to their treatment. Group 1 was patients who underwent arterial bypass surgery (n=84) and group 2 with conservative management of exercise and medication (n=61). in case of significant iliac arterial stenosis, balloon angioplasty or ??stent insertion were added in both groups (17 in group 1, 16 in group 2). Changing of clinical manifeststaion and ankle-brachial index, claudication distance, rate of major amputation and mortality were compared between groups.
Result: There was a big difference in the rate of improving claudication distance at the end of one year after treatment (86.5% in group 1 ??vs 40.4% in group 2) but 5.4% of group 1 and 32.0% of group 2 showed aggravation of the symptoms. improved ankle-brachial index (ABI) noted in 88.1% of group 1 but in group 2, 39.3% showed increasing of ABI only under the conservative management. the proximal inflow procedure had more significant effect in improving ischemic sysmptoms and ABI in group 2 compare to group 1. One fourth of group 1 and 18.2% of group 2 showed spontaneous healing of their toe gangrene but 3.1% of group 1 and 54.5% of group 2 needed major amputation because of disease progress. New gangrene developed during their follow up and this also ended with major amputation in group 2. The difference of mortality rate between groups might be due to old age and associated cardiac disease.
Conclusion: Better results in improving ischemic symptoms and ABI with low rate of amputation and mortality encourage us to do an aggressive surgery. But significant portion of conservative group especially in patients with inflow procedures also showed improving symptoms, and this suggest us a need of significant consideration of medical and exercise treatment in selected cases.
Alternative Title
Results of Infrainguinal Chronic Arterial Occlusion: Difference in Medical and Surgical Management
Department
Dept. of Surgery (외과학)
Dept. of Radiology (영상의학)
Publisher
School of Medicine
Citation
대한혈관외과학회지, Vol.18(1) : 61-67, 2002
Type
Article
ISSN
1229-991X
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/39957
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