Presti C, Puech-Leão P, Albers M
Vascular Surgery Section, Department of Surgery, University of São Paulo Medical School, Brazil.
J Vasc Surg. 1999 Mar;29(3):413-21. doi: 10.1016/s0741-5214(99)70269-7.
The purpose of this study was to determine the results of composite artery-vein bypass grafting for infrainguinal arterial reconstruction.
This study was designed as a retrospective case series in two tertiary referral centers. Forty-eight of 51 patients underwent the procedure of interest for the treatment of ischemic skin lesions (n = 42), rest pain (n = 3), disabling claudication (n = 1), and infected prosthesis (n = 2). The intervention used was infrainguinal composite artery-vein bypass grafting to popliteal (n = 18) and infrapopliteal (n = 30) arteries, with an occluded segment of the superficial femoral artery prepared with eversion endarterectomy and an autogenous vein conduit harvested from greater saphenous veins (n = 43), arm veins (n = 3), and lesser saphenous veins (n = 2). The main outcome measures, primary graft patency rates, foot salvage rates, and patient survival rates, were described by means of the life-table method for a mean follow-up time of 15.5 months.
The cumulative loss during the follow-up period was 6% and 24% at 6 and 12 months, respectively. The primary graft patency rates, the foot salvage rates, and the patient survival rates for patients with popliteal grafts were 60.0% +/- 9.07%, 75.7% +/- 9.18%, and 93.5% +/- 6.03%, respectively, at 1 month; 53.7% +/- 11.85%, 68.9% +/- 12.47%, and 85. 0% +/- 9.92% at 1 year; and 46.7% +/- 18.19%, 68.9% +/- 20.54%, and 53.1% +/- 17.15% at 5 years. For infrapopliteal grafts, the corresponding estimates were 72.4% +/- 7.06%, 72.9% +/- 6.99%, and 92.7% +/- 4.79% at 1 month; 55.6% +/- 10.70%, 55.4% +/- 10.07%, and 77.9% +/- 9.02% at 1 year; and 33.6% +/- 22.36%, 55.4% +/- 30.20%, and 20.8% +/- 9.89% at 5 years.
The composite artery-vein bypass graft is a useful autogenous alternative for infrainguinal arterial reconstruction when a vein of the required quality is not available or when the procedure needs to be confined to the affected limb.
本研究旨在确定股腘动脉复合动静脉旁路移植术用于腹股沟下动脉重建的效果。
本研究设计为一项在两个三级转诊中心开展的回顾性病例系列研究。51例患者中有48例接受了感兴趣的手术，用于治疗缺血性皮肤病变（n = 42）、静息痛（n = 3）、致残性间歇性跛行（n = 1）和感染性假体（n = 2）。采用的干预措施是股腘动脉复合动静脉旁路移植至腘动脉（n = 18）和腘动脉以下动脉（n = 30），股浅动脉闭塞段采用外翻内膜切除术处理，自体静脉管道取自大隐静脉（n = 43）、手臂静脉（n = 3）和小隐静脉（n = 2）。主要结局指标，即原发性移植物通畅率、足部挽救率和患者生存率，采用寿命表法描述，平均随访时间为15.5个月。
随访期间6个月和12个月时的累积失访率分别为6%和24%。腘动脉移植物患者1个月时的原发性移植物通畅率、足部挽救率和患者生存率分别为60.0%±9.07%、75.7%±9.18%和93.5%±6.03%；1年时分别为53.7%±11.85%、68.9%±12.47%和85.0%±9.92%；5年时分别为46.7%±18.19%、68.9%±20.54%和53.1%±17.15%。对于腘动脉以下移植物，相应的估计值1个月时分别为72.4%±7.06%、72.9%±6.99%和92.7%±4.79%；1年时分别为55.6%±10.70%、55.4%±10.07%和77.9%±9.02%；5年时分别为33.6%±22.36%、55.4%±30.20%和20.8%±9.89%。
当无法获得所需质量的静脉或手术需要局限于患侧肢体时，复合动静脉旁路移植是腹股沟下动脉重建的一种有用的自体替代方法。
