Dardik H, Dardik I I, Sprayregen S, Ibrahim I M, Veith F J
Surgery. 1975 Feb;77(2):249-54.
Thirty-two small-vessel bypasses were constructed as limb-salvage procedures. The one month patency rate was 72 percent and the one year cumulative patency rate was 55 percent. Preoperative, intraoperative, and postoperative angiography was performed in most cases and the results correlated with the ultimate fate of the graft. Preoperative angiography is critical in determining the location of a suitable small vessel, including the peroneal artery, and the quality of the runoff. Intraoperative angiography is required to delineate correctable intraoperative defects usually appearing at the distal anastomotic area. Additionally, failure to demonstrate runoff or a pedal arch can help support a decision not to re-explore a graft should early closure occur. Postoperative angiography is essential to validate clinical success with graft patency and function. It also serves to discover potential graft defects that might otherwise lead to closure and potential limb loss. Selected cases of failed small-vessel bypass grafts may be salvaged by thrombectomy with or without graft revision. Small-vessel bypass is generally contraindicated if there is extensive tissue necrosis and infection extending into the proximal foot. In cases where the necrotizing infection is localized, particularly to the forefoot, then open drainage, debridement, or amputation should be performed together with small-vessel bypass. Finally, the risks indigenous to small-vessel bypass procedures demand optimal patient selection and exquisite operative technique.
进行了32例小血管旁路手术作为肢体挽救手术。1个月通畅率为72%，1年累积通畅率为55%。大多数病例均进行了术前、术中和术后血管造影，其结果与移植物的最终转归相关。术前血管造影对于确定合适的小血管（包括腓动脉）位置以及血流情况至关重要。术中血管造影用于明确通常出现在远端吻合区域的可纠正的术中缺陷。此外，若未能显示血流或足弓，有助于支持在移植物早期闭塞时不进行再次探查的决定。术后血管造影对于证实移植物通畅和功能的临床成功至关重要。它还用于发现可能导致闭塞和潜在肢体丧失的潜在移植物缺陷。部分小血管旁路移植物失败的病例可通过血栓切除术（伴或不伴移植物修复）挽救。如果存在广泛的组织坏死和感染蔓延至足部近端，小血管旁路手术通常是禁忌的。在坏死性感染局限的情况下，尤其是在前足，应在进行小血管旁路手术的同时行切开引流、清创或截肢。最后，小血管旁路手术固有的风险要求进行最佳的患者选择和精湛的手术技术。
