Department of Vascular Surgery, Ghent University Hospital, Gent, Belgium.
J Vasc Surg. 2010 Apr;51(4):869-77. doi: 10.1016/j.jvs.2009.11.062.
The availability of autologous vein grafts remains the limiting factor in infragenual bypass surgery in many patients with critical limb ischemia (CLI). Alternatives such as prosthetic conduits are known to have a poor outcome and most are not resistant to infection. Based on previous experimental work, we started to use cryopreserved saphenous vein allografts for this indication 15 years ago. To evaluate their outcome, we performed a retrospective study of those bypasses with distal anastomosis on a crural or pedal vessel.
Between November 1991 and December 2005, 108 cryopreserved great saphenous vein allografts were implanted for in 92 patients (42 women, 50 men) with a mean age of 71 years (range, 39-88 years). All patients received low-dose immunosuppressive therapy for up to 1 year after intervention. Follow-up was conducted until amputation, death, or the end of the study in March 2007.
Nondiabetic atherosclerosis the cause of CLI in 57%, 41% had diabetes, and 2% had Buerger disease. Forty-one conduits were performed for primary reconstructions and 67 for redo reconstructions. During a mean follow-up of 26.4 months, 69 occlusions occurred. Primary and secondary patency rates were 56% and 73% at 1 year, 32% and 60% at 3 years, and 17% and 38.5% at 5 years. Survival rates were 87.4% at 1 year and 64.5% at 5 years. At multivariate analysis, the intake of statins was predictive for improved patency (hazard ratio [HR], 0.09; P = .024) and for prolonged survival (HR, 0.335; P = .045). The presence of diabetes showed a trend for inferior patency (HR, 2.325; P = .116) and for decreased amputation risk (HR, 0.592; P = .078).
Cryopreserved saphenous vein allografts are a valuable alternative to prosthetic materials when autologous veins are not available. Our limb salvage and patency rates are higher then those described for prosthetic grafts at the infrapopliteal level in most studies. Moreover, these grafts are resistant to infection when performed for revascularization in patients with an infected ulcer. Better graft and patient selection, better graft surveillance and immunologic matching, and standard use of statins could possibly improve the results even further. Shortage in availability might be a limiting factor for their widespread use.
在许多患有严重肢体缺血（CLI）的患者中，自体静脉移植物的可用性仍然是小腿旁路手术的限制因素。众所周知，假体血管等替代品的效果不佳，而且大多数都不能抵抗感染。基于之前的实验工作，我们在 15 年前开始将冷冻保存的大隐静脉同种异体移植物用于该适应症。为了评估它们的结果，我们对那些在小腿或足部血管进行远端吻合的旁路手术进行了回顾性研究。
1991 年 11 月至 2005 年 12 月期间，92 例患者（42 名女性，50 名男性）接受了 108 例冷冻保存的大隐静脉同种异体移植物的植入手术，平均年龄为 71 岁（范围，39-88 岁）。所有患者在干预后接受了长达 1 年的低剂量免疫抑制治疗。随访至截肢、死亡或 2007 年 3 月研究结束。
非糖尿病性动脉粥样硬化导致 CLI 的占 57%，糖尿病占 41%，伯格病占 2%。41 根导管用于初次重建，67 根用于再次重建。在平均 26.4 个月的随访中，发生了 69 次闭塞。1 年时，原发性和继发性通畅率分别为 56%和 73%，3 年时分别为 32%和 60%，5 年时分别为 17%和 38.5%。1 年时的生存率为 87.4%，5 年时为 64.5%。多变量分析显示，服用他汀类药物可提高通畅率（风险比 [HR]，0.09；P =.024）和延长生存率（HR，0.335；P =.045）。糖尿病的存在显示出较低的通畅率（HR，2.325；P =.116）和较低的截肢风险（HR，0.592；P =.078）趋势。
在自体静脉不可用时，冷冻保存的大隐静脉同种异体移植物是假体材料的一种有价值的替代品。我们的肢体存活率和通畅率高于大多数研究中报道的用于治疗小腿以下部位的假体移植物的存活率和通畅率。此外，当用于治疗感染性溃疡患者的血管再通时，这些移植物不易感染。更好的移植物和患者选择、更好的移植物监测和免疫匹配、以及他汀类药物的标准使用，可能会进一步提高结果。可用性不足可能是其广泛应用的限制因素。
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