Landry Gregory J, Liem Timothy K, Mitchell Erica L, Edwards James M, Moneta Gregory L
Department of Surgery, Division of Vascular Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code OP11, Portland, OR 97239-3098, USA.
Arch Surg. 2007 Sep;142(9):848-53; discussion 853-4. doi: 10.1001/archsurg.142.9.848.
To determine differences in patients undergoing lower extremity vein graft revisions presenting with and without recurrence of preoperative symptoms.
Retrospective case-control study of a prospectively maintained database.
University and veterans' administration hospitals
Two hundred nineteen lower extremity vein graft revisions were performed in 161 patients from January 1995 to January 2007. Patients were categorized as asymptomatic or symptomatic (recurrence of initial symptoms) at the time of revision.
Univariate analysis was performed to assess differences in patient demographics, details of initial operation, site of recurrent lesion, and follow-up surveillance data between symptomatic and asymptomatic patients. Independent predictors of symptomatic recurrence were identified with multivariate logistic regression. Primary assisted patency was compared between revisions performed for symptomatic and asymptomatic lesions.
Vein graft stenoses were asymptomatic in 125 cases (57%) and symptomatic in 94 cases (43%). Symptomatic recurrences were associated with a significantly greater drop in ankle brachial index than asymptomatic lesions (mean [SD], 0.21 [0.03] vs 0.11 [0.02]; P = .003). Distal graft or outflow lesions were significantly associated with symptom recurrence (P = .048). Multivariate analysis identified ankle brachial index decrease (odds ratio, 6.803; 95% confidence interval, 1.418-32.258; P = .02) and the use of alternate graft conduit (odds ratio, 2.633, 95% confidence interval, 1.243-5.578; P = .01) as independent predictors of recurrent symptoms. Overall 5-year patency was the same regardless of preoperative symptoms (82% symptomatic and 88% asymptomatic; P = .30).
Symptomatic recurrences are associated with larger decreases in ankle brachial index, distal lesions, and alternate conduit grafts. Duplex surveillance is necessary to identify asymptomatic vein graft stenoses. Because graft patency is independent of preoperative symptoms, surveillance consisting of clinical follow-up with ankle brachial index evaluation warrants further consideration.
确定接受下肢静脉移植血管翻修术的患者术前症状有无复发的差异。
对前瞻性维护数据库进行回顾性病例对照研究。
大学医院和退伍军人管理局医院
1995年1月至2007年1月期间，161例患者接受了219次下肢静脉移植血管翻修术。在翻修时，患者被分为无症状或有症状（初始症状复发）两类。
进行单因素分析，以评估有症状和无症状患者在人口统计学特征、初次手术细节、复发病变部位以及随访监测数据方面的差异。通过多因素逻辑回归确定症状复发的独立预测因素。比较有症状和无症状病变翻修术后的初级辅助通畅率。
125例（57%）静脉移植血管狭窄无症状，94例（43%）有症状。与无症状病变相比，有症状复发与踝肱指数下降幅度明显更大有关（均值[标准差]，0.21[0.03]对0.11[0.02]；P = 0.003）。移植血管远端或流出道病变与症状复发显著相关（P = 0.048）。多因素分析确定踝肱指数下降（比值比，6.803；95%置信区间，1.418 - 32.258；P = 0.02）和使用替代移植血管 conduit（比值比，2.633，95%置信区间，1.243 - 5.578；P = 0.01）是症状复发的独立预测因素。无论术前症状如何，总体5年通畅率相同（有症状者为82%，无症状者为88%；P = 0.30）。
有症状复发与踝肱指数更大幅度下降、远端病变和替代血管移植有关。需要进行双功超声监测以识别无症状的静脉移植血管狭窄。由于移植血管通畅率与术前症状无关，由临床随访和踝肱指数评估组成的监测值得进一步考虑。
