Modrall J Gregory, Sadjadi Javid, Joiner Donald R, Ali Ahsan, Welborn M Burress, Jackson Mark R, Valentine R James, Clagett G Patrick
Division of Vascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, TX 75390-9157, USA.
J Vasc Surg. 2003 Feb;37(2):362-6. doi: 10.1067/mva.2003.21.
Gangrenous bowel, intraabdominal sepsis, and previous failed mesenteric bypass are indications for use of an autogenous conduit for mesenteric arterial reconstruction. Saphenous vein (SV) is often used as the autogenous conduit of choice, but it may be prone to graft stenosis or occlusion. Recent experience with superficial femoral vein (SFV) suggests that it is an excellent alternative conduit for major arterial reconstruction. The purpose of this study was to compare the outcomes of SV and SFV for mesenteric arterial bypass.
During a 7-year period, 26 patients underwent 43 mesenteric arterial bypass procedures with autogenous conduit. SV was used for 23 bypasses (53%), and SFV was used for 20 bypasses (47%). Indications for revascularization included chronic mesenteric ischemia (n = 15; 58%), acute mesenteric ischemia (n = 9; 35%), and mycotic aneurysm of the paravisceral aorta (n = 2; 7%). Three patients (11%) underwent revascularization with SV grafts and two patients (8%) with SFV grafts after previous failed mesenteric bypass.
The 30-day mortality rate was 15%. Three deaths occurred after SV bypass for acute mesenteric ischemia, and one death occurred after a SFV bypass for a ruptured paravisceral mycotic aneurysm. Twenty-two surviving patients were followed for a mean of 31 +/- 6 months. Three of 11 patients (27%) who survived after SV bypass had recurrent mesenteric ischemia develop (acute, n = 1; chronic, n = 2) from graft thrombosis at a mean interval of 32 +/- 22 months after surgery. No patient had recurrent symptoms develop after SFV bypass. One of the three patients with SV graft failure died of acute mesenteric ischemia, and the other two patients underwent successful bypass with SFV. Symptomatic graft failure was significantly more likely to occur in patients receiving SV grafts compared with SFV grafts (P <.05).
SFV yields acceptable clinical outcomes for mesenteric arterial bypass compared with SV. SFV is a viable alternative to SV when autogenous conduit is indicated for mesenteric arterial reconstruction.
坏疽性肠病、腹腔内脓毒症以及既往肠系膜旁路手术失败是使用自体血管移植物进行肠系膜动脉重建的指征。大隐静脉（SV）常被用作首选的自体血管移植物，但它可能易于发生移植血管狭窄或闭塞。近期有关股浅静脉（SFV）的经验表明，它是主要动脉重建的一种极佳替代血管移植物。本研究的目的是比较SV和SFV用于肠系膜动脉旁路手术的效果。
在7年期间，26例患者接受了43次使用自体血管移植物的肠系膜动脉旁路手术。23次旁路手术（53%）使用了SV，20次旁路手术（47%）使用了SFV。血运重建的指征包括慢性肠系膜缺血（n = 15；58%）、急性肠系膜缺血（n = 9；35%）以及内脏旁主动脉霉菌性动脉瘤（n = 2；7%）。3例患者（11%）在既往肠系膜旁路手术失败后接受了SV移植物血运重建，2例患者（8%）接受了SFV移植物血运重建。
30天死亡率为15%。3例患者在SV旁路手术后因急性肠系膜缺血死亡，1例患者在SFV旁路手术后因内脏旁霉菌性动脉瘤破裂死亡。22例存活患者平均随访31±6个月。11例在SV旁路手术后存活的患者中有3例（27%）出现复发性肠系膜缺血（急性，n = 1；慢性，n = 2），平均发生时间为术后32±22个月，原因是移植血管血栓形成。SFV旁路手术后无患者出现复发性症状。3例SV移植物失败的患者中有1例死于急性肠系膜缺血，另外2例患者接受了成功的SFV旁路手术。与SFV移植物相比，接受SV移植物的患者出现有症状的移植物失败明显更常见（P <.05）。
与SV相比，SFV用于肠系膜动脉旁路手术可获得可接受的临床效果。当自体血管移植物适用于肠系膜动脉重建时，SFV是SV的一种可行替代物。
