Dorrucci V, Griselli F, Petralia G, Spinamano L, Adornetto R
Department of Vascular Surgery, Umberto I Hospital, Venice, Italy.
J Cardiovasc Surg (Torino). 2008 Apr;49(2):145-9.
The use of prosthetic grafts in below-knee (BK) bypasses may be necessary in patients with no available autologous vein and critical limb ischemia not amenable to angioplasty. Such conduits, however, have generally yielded disappointing results.
A new heparin-bonded expanded polytetrafluoroethylene graft (Gore-Tex Propaten Vascular Graft) designed to provide resistance to thrombosis may be associated with decreased early graft failure and increased patency. This graft was implanted in 27 limbs (26 patients; 18 men; mean age 71 years; Rutherford class 4 to 6 disease) in a BK femoropopliteal and femorodistal location, without perioperative complications and with immediate graft patency.
During a mean follow-up time of 24 months, 4 cases of thrombosis occurred, all at least 6 months postoperatively: 2 cases resolved after fibrinolytic treatment, 1 required surgical revision and in 1 case, amputation was required because of a delay in seeking treatment for thrombosis. Two patients died of cardiac disease during follow-up. The 2-year primary and secondary patency rates for the BK bypasses were 85% and 93%, respectively; the limb-salvage rate was 96%.
These results are encouraging for a prosthetic graft, especially in the light of the severity of the vascular disease in the limbs treated.
对于没有可用自体静脉且肢体严重缺血不适于血管成形术的患者，膝下（BK）旁路手术中使用人工血管移植物可能是必要的。然而，这类血管移植物通常效果不佳。
一种新型的肝素结合型膨体聚四氟乙烯移植物（戈尔特斯普洛帕特恩血管移植物）旨在抵抗血栓形成，可能会降低早期移植物失败率并提高通畅率。该移植物被植入27条肢体（26例患者；18名男性；平均年龄71岁；卢瑟福分级为4至6级疾病）的BK股腘动脉和股远端位置，无围手术期并发症且移植物即刻通畅。
在平均24个月的随访期内，发生了4例血栓形成，均在术后至少6个月：2例经纤溶治疗后缓解，1例需要手术翻修，1例因血栓形成后寻求治疗延迟而需要截肢。2例患者在随访期间死于心脏病。BK旁路手术的2年原发性和继发性通畅率分别为85%和93%；肢体挽救率为96%。
这些结果对于人工血管移植物来说是令人鼓舞的，特别是考虑到所治疗肢体血管疾病的严重程度。
