Bergmark C, Johansson G, Olofsson P, Swedenborg J
Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
J Cardiovasc Surg (Torino). 1991 Jan-Feb;32(1):117-20.
The present report compares the in situ technique with that using the reversed vein for femoropopliteal bypass. In 1986 the in situ technique was introduced at our clinic as the preferred method for femoropopliteal bypass with the lower anastomosis below the knee or femorodistal bypass. Forty patients operated with the in situ technique were compared with an equal number of patients operated with the reversed technique 1983-1985. The two groups were comparable regarding concomitant cardiovascular and pulmonary disease, preoperative ankle-brachial index and level of distal anastomosis. Patency after 6 months was significantly higher (84%) for the in situ grafts compared to reversed veins (49%). The difference was mainly caused by a significantly higher patency for in situ grafts anastomosed to infrapopliteal arteries. Despite better patency rates in the in situ group limb salvage at 6 months was the same in both groups. Operating time was also similar in both groups. It is concluded that the in situ technique is superior to the reversed technique, at least in infrapopliteal reconstructions. The superior patency rate and the technical advantages without apparent disadvantages are the basis for the recommendation to use the in situ technique for femoropopliteal and femorodistal bypass.
本报告比较了原位技术与使用反转静脉进行股腘动脉搭桥术的情况。1986年，原位技术在我们诊所被引入，作为膝下股腘动脉搭桥术或股远端搭桥术的首选方法。将40例行原位技术手术的患者与1983 - 1985年行反转技术手术的同等数量患者进行比较。两组在合并的心血管和肺部疾病、术前踝肱指数以及远端吻合水平方面具有可比性。原位移植物6个月后的通畅率（84%）显著高于反转静脉（49%）。这种差异主要是由于与腘下动脉吻合的原位移植物通畅率显著更高。尽管原位组的通畅率更高，但两组6个月时的肢体挽救情况相同。两组的手术时间也相似。结论是，原位技术优于反转技术，至少在腘下重建中如此。较高的通畅率以及技术优势且无明显劣势是推荐在股腘动脉和股远端搭桥术中使用原位技术的依据。
