Thörne Johan, Danielsson Gudmundur, Danielsson Peter, Jonung Torbjörn, Norgren Lars, Ribbe Else, Zdanowski Zbigniew
Department of Surgery, Division of Vascular Surgery, University Hospital of Lund, Sweden.
J Vasc Surg. 2002 Apr;35(4):759-65. doi: 10.1067/mva.2002.119240.
To find out whether intraoperative angioscopic assistance has any effect on graft outcome in patients with critical leg ischemia.
One hundred one patients requiring a below-knee bypass were assigned to undergo in situ saphenous vein bypass with or without intraoperative angioscopic assistance; otherwise treated similarly including preoperative duplex vein mapping, intraoperative graft flow measurements, and angiography. Data on operative details, morbidity, hospital stay, and graft patency were collected prospectively and compared. All patients were followed up for 12 months.
The group that underwent angioscopy (A) and the control group (B) were similar in all respects, except for the number of patients enrolled in the groups (32 and 69, respectively). Angioscopy revealed incompletely destructed valves in 34 patients (range, 0 to 5; mean 1), undiagnosed vein branches in 111 patients (mean 4.3), and partly occluding thrombus in 5 patients. The number of postoperative arteriovenous fistulas with signs of failing graft and a need for angiographic or surgical reintervention were significantly higher in group B (P <.0001). The 1-year primary patency rate was significantly better in group A (P <.01), but the primary assisted and secondary patency rates did not differ between the groups.
Angioscopic assistance has an impact on primary graft patency, minimizes the risk for graft failure and thus reduces the need for reintervention by allowing identification of persistent saphenous vein branches, incomplete valve destruction, and partly occluding graft thrombus without adding extra operative time.
探讨术中血管内镜辅助对严重下肢缺血患者移植物转归是否有影响。
101例需要进行膝下旁路移植术的患者被分配接受原位大隐静脉旁路移植术，术中有无血管内镜辅助；其他治疗措施相似，包括术前双功静脉造影、术中移植物血流测量及血管造影。前瞻性收集并比较手术细节、发病率、住院时间和移植物通畅性的数据。所有患者均随访12个月。
接受血管内镜检查的组（A组）和对照组（B组）在各方面均相似，只是两组纳入的患者数量不同（分别为32例和69例）。血管内镜检查发现34例患者瓣膜未完全破坏（范围0至5个；平均1个），111例患者有未被诊断出的静脉分支（平均4.3个），5例患者有部分阻塞性血栓。B组术后出现动静脉瘘且伴有移植物功能衰竭迹象以及需要进行血管造影或手术再次干预的数量明显更高（P<.0001）。A组的1年原发性通畅率明显更好（P<.01），但两组的原发性辅助通畅率和继发性通畅率没有差异。
血管内镜辅助对移植物原发性通畅有影响，可将移植物失败的风险降至最低，从而通过识别持续存在的大隐静脉分支、不完全瓣膜破坏和部分阻塞性移植物血栓，在不增加额外手术时间的情况下减少再次干预的需求。
