Castier Y, Lesèche G, Palombi T, Petit M D, Cerceau O
Service de Chirurgie Vasculaire et Thoracique, Hôpital Beaujon, Clichy, France.
Am J Surg. 1999 Mar;177(3):197-202. doi: 10.1016/s0002-9610(99)00010-0.
Below-knee revascularization for limb salvage in the absence of a suitable autogenous saphenous vein is a frequent challenge associated with a high amputation rate. The aim of this prospective study was to evaluate the usefulness of cryopreserved arterial allografts in such cases.
Arterial allografts were harvested from multiple organ donors and cryopreserved at -80 degrees C. From March 1993 to December 1997, 35 cryopreserved arterial allografts were used as below-knee bypasses for repeated limb salvage in 32 patients. There were 15 men and 17 women with a mean age of 75 years (+/-10.7). Seven patients had rest pain and 25 patients (78%) had gangrene or nonhealing ulceration. Runoff was through a single tibial vessel in 25 cases (71%) and two vessels in 10 cases. Previous ipsilateral bypasses had been done in 26 of 35 limbs (74%). Patients were followed up prospectively for an average period of 18 months (range 2 to 56).
Aneurysmal dilatation occurred in two patent grafts, requiring segmental replacement at 13 and 18 months, respectively. The overall primary patency rate was 75% at 6 months, 57% at 12 months, and 39% at 18 months. The overall secondary patency rate was 75% at 6 months, 75% at 12 months, and 59% at 18 months. Overall limb salvage rate was 80% at 12 months, 73% at 18 months.
These early data indicate that below-knee bypass with arterial allografts results in acceptable patency and limb salvage. Arterial allografts may be a useful alternative to other arterial substitutes in a difficult group of patients with critical ischemia and no suitable saphenous vein.
在没有合适的自体大隐静脉的情况下，为挽救肢体而进行的膝下血管重建是一项常见的挑战，截肢率很高。这项前瞻性研究的目的是评估冷冻保存的动脉同种异体移植物在这类病例中的效用。
从多个器官捐献者获取动脉同种异体移植物，并在-80℃下冷冻保存。1993年3月至1997年12月，35个冷冻保存的动脉同种异体移植物被用作膝下旁路移植，用于32例患者的反复肢体挽救。其中男性15例，女性17例，平均年龄75岁（±10.7）。7例患者有静息痛，25例患者（78%）有坏疽或不愈合溃疡。25例（71%）的血流通过单一胫血管，10例通过两条血管。35条肢体中的26条（74%）之前进行过同侧旁路移植。对患者进行前瞻性随访，平均随访期为18个月（范围2至56个月）。
两个通畅的移植物发生了动脉瘤样扩张，分别在13个月和18个月时需要进行节段性置换。总的原发性通畅率在6个月时为75%，12个月时为57%，18个月时为39%。总的继发性通畅率在6个月时为75%，12个月时为75%，18个月时为59%。总的肢体挽救率在12个月时为80%，18个月时为73%。
这些早期数据表明，使用动脉同种异体移植物进行膝下旁路移植可获得可接受的通畅率和肢体挽救率。在患有严重缺血且没有合适大隐静脉的困难患者群体中，动脉同种异体移植物可能是其他动脉替代物的有用替代品。
