de Mello A V, Santos C M, Silva J L, Souza M T, Portilho M A, Guimarães A V, Freitas R G, Silvério J W
Vascular Service, Jacarepaguá General Hospital, National Institute of Social Welfare, Rio de Janeiro, Brazil.
Int Angiol. 1991 Jul-Sep;10(3):126-32.
The authors describe their initial experience with the use of the in situ saphenous vein arterial by-pass technique for infrainguinal revascularization. From December 1986 to August 1989, we performed 101 in situ saphenous vein arterial by-passes. From these 101 by-pass, 18 composite or partial in situ vein by-passes (in situ + reversed vein) and 2 extra-anatomical sequencial by-passes (one axillofemoral and one cross-over femorofemoral proximal by-passes extended by in situ saphenous vein femoropopliteal arterial by-passes) were withdrawn from the statistics, with the purpose of analysing the natural evolution of the in situ vein arterial by-pass without the insertion of reversed vein segments and/or the influence of artificial grafts to improve arterial inflow. Therefore only 81 in situ by-pass cases will be analysed in the present paper. From these 81 cases, 44 (54.3%) were performed in diabetic patients and limb salvage was the indication for by-pass in 63 (81%). The saphenous vein valves were rendered incompetent utilising the retrograde Mills-Leather valvulotome and exposing the greater saphenous vein with a continuous incision. In the 81 cases, wound complications occurred in 18 limbs (22%) and operative mortality (30 days) was 6.1%. Primary cumulative patency rate of the 81 cases was 77% and secondary cumulative patency rate was 80%, at the end of the analysed period. The open technique, using a retrograde valvulotome and exposing the entire conduit of the greater saphenous vein, became our preferred technique for infrainguinal revascularization.
作者描述了他们使用原位大隐静脉动脉旁路技术进行腹股沟下血管重建的初步经验。1986年12月至1989年8月，我们进行了101例原位大隐静脉动脉旁路手术。在这101例旁路手术中，18例复合或部分原位静脉旁路手术（原位+翻转静脉）和2例解剖外序贯旁路手术（1例腋股旁路和1例交叉股股近端旁路，通过原位大隐静脉股腘动脉旁路进行延伸）被排除在统计之外，目的是分析不插入翻转静脉段的原位静脉动脉旁路的自然演变情况和/或人工移植物对改善动脉血流的影响。因此，本文仅分析81例原位旁路手术病例。在这81例病例中，44例（54.3%）在糖尿病患者中进行，63例（81%）的旁路手术指征为肢体挽救。使用逆行Mills-Leather瓣膜刀使大隐静脉瓣膜功能不全，并通过连续切口暴露大隐静脉。在这81例病例中，18条肢体（22%）发生伤口并发症，手术死亡率（30天）为6.1%。在分析期结束时，81例病例的原发性累积通畅率为77%，继发性累积通畅率为80%。使用逆行瓣膜刀并暴露大隐静脉整个管道的开放技术，成为我们进行腹股沟下血管重建的首选技术。
