Tofigh A Mohammadi, Warnier De Wailly G, Rhissassi B
Department of Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Surg. 2007 Apr;5(2):109-13. doi: 10.1016/j.ijsu.2006.07.003. Epub 2006 Aug 14.
Despite many clinical studies, there is still uncertainty as to whether venous material is superior to prosthetic materials for femoropopliteal reconstruction proximal to the knee joint. A prospectively randomized clinical trial was designed to evaluate the effectiveness of reversed saphenous vein in comparison with that of collagen impregnated woven polyester prosthesis in above-knee arterial reconstruction.
In a 3-year period, 103 above-knee femoropopliteal bypass graft operations were performed and followed in 85 patients (52 male, 33 female). The indication for operation was severe claudication in 74 cases, rest pain in 7 cases, and ulceration in 4 cases. For the bypass graft, a reversed saphenous vein was used in each of 51 cases, and a collagen impregnated woven polyester prosthesis was used in each of 52 cases. Preoperative risk factors were diabetes (24%), a history of myocardial infarction (23%), and current status with respect to smoking (74%). There was no hospital mortality; 5% of patients had minor postoperative complications.
After 2 years of follow-up, the primary patency was 81% for saphenous vein and 67% for collagen impregnated woven polyester prosthesis (P=0.065); the secondary patency was 81% for saphenous vein and 77% for collagen impregnated woven polyester prosthesis (P=0.298). During this follow-up period of 2 years, we found no statistically significant difference in primary and secondary patency between saphenous vein and collagen impregnated woven polyester prosthesis. We found no predictive factor for the occlusion of either bypass graft.
The use of collagen impregnated woven polyester prosthesis above the knee is a reasonable alternative in femoropopliteal bypass grafting that is associated with acceptable short-term patency rates.
尽管有许多临床研究，但对于膝关节近端股腘动脉重建，静脉材料是否优于人工材料仍存在不确定性。设计了一项前瞻性随机临床试验，以评估在膝上动脉重建中，大隐静脉反转术与胶原浸渍编织聚酯人工血管相比的有效性。
在3年期间，对85例患者（52例男性，33例女性）进行了103例膝上股腘动脉搭桥手术并进行随访。手术指征为重度间歇性跛行74例、静息痛7例、溃疡4例。对于搭桥手术，51例使用大隐静脉反转术，52例使用胶原浸渍编织聚酯人工血管。术前危险因素包括糖尿病（24%）、心肌梗死病史（23%）和当前吸烟状况（74%）。无住院死亡病例；5%的患者有轻微术后并发症。
随访2年后，大隐静脉的一期通畅率为81%，胶原浸渍编织聚酯人工血管为67%（P=0.065）；大隐静脉的二期通畅率为81%，胶原浸渍编织聚酯人工血管为77%（P=0.298）。在这2年的随访期间，我们发现大隐静脉与胶原浸渍编织聚酯人工血管在一期和二期通畅率方面无统计学显著差异。我们未发现任何一种搭桥血管闭塞的预测因素。
在膝上股腘动脉搭桥手术中，使用胶原浸渍编织聚酯人工血管是一种合理的选择，其短期通畅率可以接受。
