Comparison of the efficacy of great saphenous vein arterialization surgery and endovascular surgery in the treatment of thromboangiitis obliterans
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Department of Vascular and Thyroid Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China

Clc Number:

R654.3

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    Abstract:

    Background and Aims Thromboangiitis obliterans (TAO) is an organic disease affecting small and medium-sized arteries and veins in the extremities. Its cause is unknown, and treatment options are limited. With advances in medical technology, the most commonly used methods are great saphenous vein arterialization surgery and endovascular surgery. However, there is no consensus on the superiority of these two procedures. Therefore, this study was performed to compare the clinical efficacy of great saphenous vein arterialization surgery and endovascular surgery in treating TAO, aiming to provide a reference for clinical treatment.Methods The clinical and follow-up data of 183 patients diagnosed with TAO at the First Affiliated Hospital of Xinjiang Medical University from January 2015 to April 2023 were retrospectively analyzed. Among them, 40 patients underwent great saphenous vein arterialization (great saphenous vein arterialization group), and 143 patients underwent endovascular treatment (endovascular treatment group). The patients were matched 1:1 based on age (±5 years) and TASC classification of the lesion segment, resulting in 36 pairs of patients, all male. Relevant clinical indicators were compared between the two groups.Results There were no statistically significant differences in the baseline data between the two groups after matching (all P>0.05). The great saphenous vein arterialization group showed better postoperative patency rates and ankle-brachial index than the endovascular treatment group and a lower rate of secondary surgical interventions (all P<0.05). The endovascular treatment group had better outcomes regarding postoperative pain visual analogue scale scores, intermittent claudication, and length of hospital stay, than the great saphenous vein arterialization group (all P<0.05). The two groups had no significant differences regarding postoperative foot coldness/numbness, gangrene, amputation rates, and postoperative infection (all P>0.05). Kaplan-Meier curve analysis indicated that the long-term prognosis was better in the great saphenous vein arterialization group (P<0.05).Conclusion Compared to endovascular treatment, great saphenous vein arterialization surgery is more effective in treating TAO, offering higher patency rates and lower secondary surgical intervention rates, lower costs, and better mid-to-long-term efficacy. For patients with financial difficulties, great saphenous vein arterialization surgery may be a choice to improve mid-to-long-term outcomes. Although endovascular treatment provides better short-term clinical efficacy, such as relief from resting pain, its long-term prognosis is less favorable than great saphenous vein arterialization surgery. Therefore, without suitable vascular grafts, endovascular surgery is optional to reduce postoperative pain and improve the patient's quality of life.

    图1 大隐静脉动脉化手术 A:TAO患者血管炎性表现;B:大隐静脉搭桥手术操作Fig.1 Great saphenous vein arterialization surgery A: Vasculitis manifestations in TAO patients; B: Great saphenous vein bypass surgery operation
    图2 腔内手术TAO患者血管影像学表现及腔内操作 A:病变段与健康段分界明显,且健康段正常,无动脉硬化表现;B:血管闭塞段及其建立的侧支循环;C:出现特征性螺旋状周围侧支血管;D:血管易痉挛,出现典型的痉挛环Fig.2 Vascular imaging manifestations and endovascular procedures in TAO patients A: The demarcation between the affected and healthy segments is distinct, with the healthy segment appearing normal and free of atherosclerosis; B: The occluded segment and its collateral circulation; C: The characteristic helical peripheral collateral vessels; D: Typical spasm ring observed due to the tendency of vascular spasm
    图3 两组患者随访期间下肢血管闭塞复发的Kaplan-Meier曲线Fig.3 Kaplan-Meier curve of lower limb vascular occlusion recurrence during follow-up in the two groups of patients
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ZAIYING·Yeerbao, DI Tao, LI Hu, TIAN Ye. Comparison of the efficacy of great saphenous vein arterialization surgery and endovascular surgery in the treatment of thromboangiitis obliterans[J]. Chin J Gen Surg,2024,33(6):935-942.
DOI:10.7659/j. issn.1005-6947.2024.06.009

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History
  • Received:August 01,2023
  • Revised:September 26,2023
  • Online: July 09,2024