Wladis A R, Mesh C L, White J, Zenni G C, Fischer D B, Arbaugh J J
Good Samaritan Hospital, Cincinnati, OH, USA.
J Vasc Surg. 2000 Nov;32(5):997-1005. doi: 10.1067/mva.2000.108638.
Angioaccess for hemodialysis in an extremity with disadvantaged venous outflow has reduced long-term patency. We hypothesized that arteriovenous bridge graft patency could be improved in patients with disadvantaged venous outflow by preoperative venous duplex mapping.
The charts of 114 patients who underwent 115 prosthetic arteriovenous bridge grafts were reviewed. Disadvantaged venous outflow was defined on the basis of any combination of prior arteriovenous bridge graft, multiple venipunctures, and clinical examination. Patients were grouped according to the presence or absence of disadvantaged venous outflow. Three groups were analyzed: those with normal venous outflow who had an initial arteriovenous bridge graft (NML), those with disadvantaged venous outflow who had only a clinical examination before redo arteriovenous bridge graft (REDO/DVO), and those with disadvantaged venous outflow who underwent preoperative duplex scanning venous evaluation (MAP/DVO). Life table primary and secondary 12-month patency rates were compared by means of log-rank analysis.
Life table analysis yielded 6-month primary patency rates of 65.9% +/- 5.7%, 66.4% +/- 7.3%, and 43.8% +/- 10.9% for NML, MAP/DVO, and REDO/DVO, respectively. The secondary patency rates at 6 months for NML (91.9% +/- 3.4%) and MAP/DVO (91.1% +/- 4. 9%) were statistically equivalent, and both were significantly better than the patency for REDO/DVO (75.0% +/- 10.0%; P =.004 and P =.04, respectively). This trend persisted beyond 12 months.
Preoperative evaluation of venous anatomy in patients with disadvantaged venous outflow results in an arteriovenous bridge graft patency comparable to that seen in patients undergoing initial arteriovenous bridge grafts. Vein mapping improves arteriovenous bridge graft durability in the patient with disadvantaged venous outflow by allowing the surgeon to select venous return that is in direct continuity with the central venous system.
在静脉流出道不佳的肢体上建立用于血液透析的血管通路，其长期通畅率会降低。我们推测，对于静脉流出道不佳的患者，术前进行静脉超声造影检查可以提高动静脉搭桥移植物的通畅率。
回顾了114例接受115次人工动静脉搭桥移植手术患者的病历。静脉流出道不佳是根据既往动静脉搭桥移植、多次静脉穿刺和临床检查的任何组合来定义的。患者根据是否存在静脉流出道不佳进行分组。分析了三组：静脉流出道正常且首次接受动静脉搭桥移植的患者（NML）；静脉流出道不佳且在再次进行动静脉搭桥移植前仅接受临床检查的患者（REDO/DVO）；静脉流出道不佳且接受术前超声造影静脉评估的患者（MAP/DVO）。通过对数秩分析比较寿命表中的12个月一级和二级通畅率。
寿命表分析得出，NML、MAP/DVO和REDO/DVO组6个月的一级通畅率分别为65.9%±5.7%、66.4%±7.3%和43.8%±10.9%。NML组（91.9%±3.4%）和MAP/DVO组（91.1%±4.9%）6个月时的二级通畅率在统计学上相当，且均显著优于REDO/DVO组（75.0%±10.0%；P分别为0.004和0.04）。这种趋势在12个月后仍然存在。
对静脉流出道不佳的患者进行术前静脉解剖评估，其动静脉搭桥移植物的通畅率与首次接受动静脉搭桥移植的患者相当。静脉造影通过让外科医生选择与中心静脉系统直接相连的静脉回流，提高了静脉流出道不佳患者动静脉搭桥移植物的耐用性。
