Idu M M, Buth J, Hop W C, Cuypers P, van de Pavoordt E D, Tordoir J M
Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
Eur J Vasc Endovasc Surg. 1999 Jan;17(1):15-21. doi: 10.1053/ejvs.1998.0676.
To assess the influence of clinical and graft factors on the development of stenotic lesions. In addition the implications of any significant correlation for duplex surveillance schedules or surgical bypass techniques was examined.
In a prospective three centre study, preoperative and peroperative data on 300 infrainguinal autologous vein grafts was analysed. All grafts were monitored by a strict duplex surveillance program and all received an angiogram in the first postoperative year. A revision was only performed if there was evidence of a stenosis of 70% diameter reduction or greater on the angiogram.
The minimum graft diameter was the only factor correlated significantly with the development of a significant graft stenosis (PSV-ratio > or = 2.5) during follow-up (p = 0.002). Factors that correlated with the development of event-causing graft stenosis, associated with revision or occlusion, were minimal graft diameter (p = 0.001), the use of a venovenous anastomosis (p = 0.005) and length of the graft (p = 0.025). Multivariate regression analysis revealed that the minimal graft diameter was the only independent factor that significantly correlated with an event-causing graft stenosis (p = 0.009). The stenosis-free rates for grafts with a minimal diameter < 3.5 mm, between 3.5-4.5 and > or = 4.5 mm were 40%, 58% and 75%, respectively (p = < 0.05). Composite vein and arm-vein grafts with minimal diameters > or = 3.5 mm were compared with grafts which consisted of a single uninterrupted greater saphenous vein with a minimal diameter of < 3.5 mm. One-year secondary patency rates in these categories were of 94% and 76%, respectively (p = 0.03).
A minimal graft diameter < 3.5 mm was the only factor that significantly correlated with the development of a graft-stenosis. However, veins with larger diameters may still develop stenotic lesions. Composite vein and arm-vein grafts should be used rather than uninterrupted small caliber saphenous veins.
评估临床因素和移植物因素对狭窄性病变发展的影响。此外，还研究了任何显著相关性对双功超声监测计划或外科搭桥技术的意义。
在一项前瞻性三中心研究中，分析了300例腹股沟下自体静脉移植物的术前和术中数据。所有移植物均通过严格的双功超声监测计划进行监测，且在术后第一年都接受了血管造影。仅当血管造影显示直径缩小70%或更大的狭窄证据时才进行翻修。
随访期间，最小移植物直径是与显著移植物狭窄（PSV比率≥2.5）发展显著相关的唯一因素（p = 0.002）。与导致事件的移植物狭窄发展相关的因素，包括翻修或闭塞，有最小移植物直径（p = 0.001）、使用静脉-静脉吻合术（p = 0.005）和移植物长度（p = 0.025）。多因素回归分析显示，最小移植物直径是与导致事件的移植物狭窄显著相关的唯一独立因素（p = 0.009）。最小直径<3.5 mm、3.5 - 4.5 mm和≥4.5 mm的移植物无狭窄率分别为40%、58%和75%（p < 0.05）。将最小直径≥3.5 mm的复合静脉和臂静脉移植物与由单一不间断的大隐静脉组成且最小直径<3.5 mm的移植物进行比较。这些类别中的一年二次通畅率分别为94%和76%（p = 0.03）。
最小移植物直径<3.5 mm是与移植物狭窄发展显著相关的唯一因素。然而，直径较大的静脉仍可能发生狭窄性病变。应使用复合静脉和臂静脉移植物而非不间断的小口径大隐静脉。
