Department of Surgery, University of Florida and the Malcom Randall VA Medical Center, Gainesville, FL 32610-0286, USA.
Semin Vasc Surg. 2009 Dec;22(4):261-6. doi: 10.1053/j.semvascsurg.2009.10.009.
Once the failing vein graft is identified and characterized, the clinician must choose the appropriate intervention to maintain graft patency. Limited by the single-institution, retrospective studies that are pervasive in this area, definitive data to guide these decisions are limited. In general, open surgical revisions appear to offer a modest benefit in primary patency, but likely at the cost of increased periprocedural morbidity. Although endovascular revisions are more prone to failure, these recurrent lesions are often amenable to reintervention so that the secondary patency rates for both endovascular and open interventions may be similar. Given this, endovascular intervention as an initial treatment modality seems a reasonable approach for favorable lesions. Factors associated with poor outcome for endovascular revision include longer lesions (stenosis >2 cm in length), multiple stenoses, lesions occurring within 3 months of graft placement, or interventions for graft thrombosis, where endovascular failures are high and open surgery as an initial approach is warranted. The optimum method for percutaneous intervention remains a shifting landscape. No techniques as of yet appear clearly superior to standard balloon angioplasty, but initial investigations would suggest that cutting balloons offer a modest improvement and are worthy of consideration.
一旦确定并描述了病变的静脉移植物，临床医生必须选择适当的干预措施以维持移植物通畅。由于该领域普遍存在限于单一机构的回顾性研究，因此指导这些决策的明确数据有限。一般来说，开放手术修复似乎在原发性通畅方面提供了适度的益处，但可能以增加围手术期发病率为代价。尽管血管内修复更容易失败，但这些复发性病变通常可以再次进行干预，因此血管内和开放干预的二级通畅率可能相似。有鉴于此，血管内介入作为初始治疗方法似乎是一种合理的方法，适用于有利的病变。与血管内修复不良结局相关的因素包括：较长的病变（狭窄长度>2 厘米）、多处狭窄、病变发生在移植物放置后 3 个月内、或干预治疗移植物血栓形成，在这些情况下，血管内失败率较高，需要初始采用开放手术。经皮介入的最佳方法仍然在不断变化。目前还没有任何技术明显优于标准球囊血管成形术，但初步研究表明，切割球囊提供了适度的改善，值得考虑。
