Mills J L, Taylor S M
Department of Vascular Surgery, United States Air Force Medical Center, Lackland Air Force Base, Texas 78236-5300.
Ann Vasc Surg. 1991 Mar;5(2):156-62. doi: 10.1007/BF02016749.
To determine the outcome of infrainguinal reversed vein bypasses in the modern era, we reviewed the results of 120 consecutive reversed vein grafts performed from March, 1986 to March, 1990. Forty-nine bypasses were to tibial, peroneal, or pedal arteries, 46 grafts to the below-knee popliteal artery, and 25 grafts to the above-knee popliteal artery. Limb salvage was the indication for revascularization in 70% of patients. All grafts were followed with serial, duplex scan, peak-systolic graft flow velocity measurements every three months for one year and every six months thereafter. The primary life table patency rate at 36 months was 67.6% for the entire series; the secondary patency rate was 92.5%. The secondary patency rate reflects the impact of graft revisions resulting from the detection of failing grafts by duplex scanning. Patency rates of reversed vein grafts to the tibial arteries at 36 months (73.8% primary and 89.8% secondary) were equivalent to those performed to the popliteal artery. Our current patency rates with reversed vein grafts are comparable or superior to those reported for in-situ vein conduits and suggest that operative technique and meticulous follow-up are more important with respect to long-term graft durability than whether the vein is used in the in-situ or reversed configuration.
为了确定现代低位股动脉以下静脉转流术的疗效，我们回顾了1986年3月至1990年3月连续进行的120例静脉转流术的结果。其中49例转流至胫动脉、腓动脉或足背动脉，46例转流至膝下腘动脉，25例转流至膝上腘动脉。70%的患者以肢体挽救作为血管重建的指征。所有移植物在术后1年内每3个月进行一次连续的双功超声扫描，测量移植物收缩期峰值血流速度，此后每6个月进行一次。整个系列在36个月时的主要生命表通畅率为67.6%；次要通畅率为92.5%。次要通畅率反映了通过双功超声扫描检测到移植物功能衰竭后进行移植物修复所产生的影响。转流至胫动脉的静脉移植物在36个月时的通畅率（主要通畅率73.8%，次要通畅率89.8%）与转流至腘动脉的移植物相当。我们目前静脉转流术的通畅率与原位静脉管道报道的通畅率相当或更高，这表明对于移植物的长期耐用性而言，手术技术和细致的随访比静脉是采用原位还是转流配置更为重要。
