Chang B B, Paty P S, Shah D M, Leather R P
Vascular Surgery Section, Albany Medical College, New York, NY.
J Vasc Surg. 1992 Jan;15(1):152-6; discussion 156-7. doi: 10.1067/mva.1992.33186.
Use of the ipsilateral greater saphenous vein for arterial bypass procedures is frequently limited by previous stripping, bypass operations, or anatomic unsuitability. In such cases the contralateral greater saphenous vein or arm veins are often used. However, over the past 5 years we have used the lesser saphenous vein as a preferred alternative autogenous vein. Duplex scanning has been used in 311 cases for preoperative mapping and assessment with excellent correlation with actual anatomy found at operation. Harvest of the lesser saphenous vein has been facilitated by the use of a medial subfascial approach not requiring special positioning of the leg. A total of 91 lesser saphenous veins have been used for arterial bypass procedures; 66 of these were repeat cases. Vein use was 90.2%. In 40 of these cases the lesser saphenous vein was used as the entire conduit, including 10 in situ, 20 reversed vein (including 18 for coronary artery bypass), and 10 orthograde vein bypasses. In the remaining 33 cases the lesser saphenous vein was spliced to another vein to complete a bypass procedure. In the entire group, patency was 77% at 2 years. These data suggest that the lesser saphenous vein should be a principal alternative to ipsilateral greater saphenous vein for arterial bypass because of its ready availability, high use rate, ease of harvesting and preparation, and ideal handling characteristics.
同侧大隐静脉用于动脉搭桥手术常因既往已行剥脱术、搭桥手术或解剖结构不合适而受到限制。在这种情况下，常使用对侧大隐静脉或上肢静脉。然而，在过去5年中，我们已将小隐静脉作为首选的自体静脉替代物。在311例病例中使用了双功扫描进行术前定位和评估，其与手术中实际解剖结构的相关性极佳。采用内侧筋膜下途径采集小隐静脉，无需对腿部进行特殊体位摆放，操作更为简便。共有91条小隐静脉用于动脉搭桥手术；其中66例为再次手术病例。静脉使用率为90.2%。在这些病例中，40例使用小隐静脉作为整个管道，包括10例原位使用、20例静脉翻转（包括18例用于冠状动脉搭桥）和10例顺行静脉搭桥。在其余33例病例中，小隐静脉与另一根静脉拼接以完成搭桥手术。在整个组中，2年时通畅率为77%。这些数据表明，由于小隐静脉易于获取、使用率高、易于采集和制备以及具有理想的操作特性，应将其作为动脉搭桥手术中同侧大隐静脉的主要替代物。
