Johnson W C, Lee K K
Boston VA Medical Center, MA 02130, USA.
J Vasc Surg. 1999 Dec;30(6):1077-83. doi: 10.1016/s0741-5214(99)70046-7.
Currently, the choice of a vascular prosthesis for an extra-anatomic arterial bypass graft is left to the surgeon's preference because well-designed comparative evaluations have not been performed. The Department of Veterans Affairs Cooperative Study 141 was organized to identify whether there is improved patency with different prosthetic grafts for patients with femorofemoral or axillofemoral bypass grafts.
Between June 1983 and June 1988, patients at 20 Veterans Affairs Medical Centers who had aortoiliac occlusive disease but were not considered suitable candidates for aortic bypass surgery were randomized to receive either an externally supported polytetrafluoroethylene or Dacron bypass graft for an extra anatomic bypass. Doppler-derived ankle brachial indices (ABIs) were determined before the operation and serially after the operation. Patients were seen in follow-up every 3 months for the first year and every 6 months thereafter. All patients were instructed to take 650 mg of aspirin each day for the duration of the study. A bypass graft was considered to be patent if the Doppler-derived postoperative ABI remained significantly improved (0.15 units above the preoperative value), and additional clinical information (such as subsequent ABIs, angiograms, or operations) did not contradict these observations.
Three hundred forty patients with femorofemoral bypass grafts and 79 patients with axillofemoral or axillofemorofemoral bypass grafts were randomized. The indication for the bypass operation was limb salvage in 72% of the patients. The assisted primary patency rate for a Dacron bypass grafting was 79% at 1 year, 63% at 3 years, and 50% at 5 years; for polytetrafluoroethylene bypass grafting, the patency was 77% at 1 year, 62% at 3 years, and 47% at 5 years.
The overall results of this prospective randomized study suggest that the current choices of prosthetic bypass grafting have similar long-term patency in patients who undergo femorofemoral or axillofemoral vascular reconstruction.
目前，由于尚未进行精心设计的对比评估，用于解剖外动脉旁路移植的血管假体的选择取决于外科医生的偏好。退伍军人事务部合作研究141旨在确定对于行股-股或腋-股旁路移植术的患者，不同的人工血管移植物是否能提高通畅率。
1983年6月至1988年6月期间，20家退伍军人事务医疗中心的患有主-髂动脉闭塞性疾病但不被认为适合主动脉旁路手术的患者被随机分配接受外部支撑的聚四氟乙烯或涤纶旁路移植物进行解剖外旁路移植。术前测定经多普勒得出的踝肱指数（ABI），术后连续测定。术后第一年每3个月随访一次，此后每6个月随访一次。在研究期间，所有患者均被要求每天服用650毫克阿司匹林。如果术后经多普勒得出的ABI仍有显著改善（比术前值高0.15个单位），且其他临床信息（如后续的ABI、血管造影或手术情况）与这些观察结果不矛盾，则认为旁路移植物通畅。
340例行股-股旁路移植术的患者和79例行腋-股或腋-股-股旁路移植术的患者被随机分组。72%的患者进行旁路手术的指征是挽救肢体。涤纶旁路移植术的辅助原发性通畅率在1年时为79%，3年时为63%，5年时为50%；聚四氟乙烯旁路移植术的通畅率在1年时为77%，3年时为62%，5年时为47%。
这项前瞻性随机研究的总体结果表明，对于行股-股或腋-股血管重建的患者，目前人工旁路移植的选择具有相似的长期通畅率。
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