Diethrich E B, Santiago O, Bahadir I
Department of Cardiovascular Surgery, Arizona Heart Institute, Phoenix.
Angiology. 1991 Jul;42(7):576-80. doi: 10.1177/000331979104200709.
Late failure of peripheral bypass grafts has been treated primarily by secondary reconstruction. Laser-assisted angioplasty is an optional therapy that the authors investigated in 28 prosthetic grafts over a two-year period. Twenty-five symptomatic patients with 28 peripheral prosthetic arterial bypass grafts (25 polytetrafluoroethylene [PTFE] grafts and 1 each of knitted Dacron, Teflon, and umbilical vein) demonstrated graft occlusion (25) or high-grade stenoses (3). All patients underwent standard laser-assisted angioplasty using a continuous wave Nd:YAG laser source and hybrid probe. Twenty-one grafts (75%) were successfully recanalized with adequate restoration of flow through the conduit. All 7 failures were in occluded PTFE grafts that presented with either recalcitrant lesions (5) or perforations (2) at the distal anastomoses. There have been 3 long-term failures (14%) to date in the successfully treated group, all in PTFE grafts. Two patients suffered recurrent thrombosis and 1 developed an inexplicable graft infection five months after laser treatment. Laser-assisted angioplasty appears to be a clinically viable alternative treatment for prosthetic graft stenosis and recanalization of grafts occluded at their distal anastomosis.
外周旁路移植血管的晚期失败主要通过二次重建进行治疗。激光辅助血管成形术是一种可供选择的治疗方法，作者在两年时间里对28条人工血管进行了研究。25例有症状的患者有28条外周人工动脉旁路移植血管（25条聚四氟乙烯[PTFE]血管，以及各1条针织涤纶血管、特氟龙血管和脐静脉血管），均表现为移植血管闭塞（25条）或高度狭窄（3条）。所有患者均使用连续波Nd:YAG激光源和混合探头进行标准的激光辅助血管成形术。21条移植血管（75%）成功再通，血管内血流得到充分恢复。所有7例失败均发生在闭塞的PTFE移植血管，这些血管在远端吻合口处出现顽固病变（5例）或穿孔（2例）。在成功治疗的组中，迄今为止有3例长期失败（14%），均发生在PTFE移植血管。2例患者出现复发性血栓形成，1例在激光治疗5个月后发生不明原因的移植血管感染。激光辅助血管成形术似乎是治疗人工血管狭窄以及远端吻合口闭塞的移植血管再通的一种临床上可行的替代治疗方法。
