Slais M, Mitás P, Semrád M, Hrubý J, Lindner J, Stádler P
II chirurgická klinika kardiovaskulární chirurgie VFN a 1. LF UK.
Rozhl Chir. 2010 Jan;89(1):59-63.
Most cases of distal bypasses closures are caused by reduced blood flow within the affected peripheral vasculature, resulting in corresponding reduction in the graft's blood supply. The authors use multiple, sequence, Y grafting and bridge grafting procedures on crural and pedal arteries, in order to improve the above hemodynamic features. Furthermore, the techniques facilitate better circulation within larger extremity regions.
From April 2007 to January 2009, the authors completed a total of 38 sequence bypass procedures. The procedures included 30 Y graft procedures with peripheral anastomoses with crural arteries, 4 Y graft procedures with peripheral anastomoses with pedal arteries and 4 bridge graft procedures. Y grafting is a technique, in which a classical distal bypass is formed, to which another bypass is attached end-to-side in an acute angle. The composite bypasses form a reversed letter Y. Its distal branches anastomose with crural or pedal arteries. Bridge grafting is a technique, where a short bypass between crural arteries is formed, using a venous graft with removed valves, allowing for a two-way flow. The distal anastomosis is attached end-to-side. All the above vascular reconstructions were indicated for critical extremity ischemia, some patients had a history of endovascular reinterventions. In the patient group, autologous veins were used in 20 reconstructions, while PTFE prostheses were used in 10 reconstructions. Clinical and sonographic examinations were performed on discharge, followed by check ups at 1,3, 6 and 12 months.
The follow up period in patients with Y graft reconstructions was 6-20 months (mean duration of 12 months). Two patients underwent major amputation, required for bypass closures, 3 subjects exited with patent vascular reconstructions, their deaths were not related to the procedure. The authors recorded 4 bypass closures, with the main trunk patency. Primary/secondary 30-day patency rate was 90%/97%, the long-term patency rate was 93%.
The vascular reconstructions results are similar to those presented in literature. In order to perform more accurate assessment of individual revascularization variants, long- term follow up studies, including randomized studies, are required.
大多数远端旁路移植术失败的病例是由于受影响的外周血管内血流减少，导致移植血管的血供相应减少。作者采用多个、序贯、Y形移植和桥式移植手术处理小腿和足部动脉，以改善上述血流动力学特征。此外，这些技术有助于在更大的肢体区域内实现更好的血液循环。
从2007年4月至2009年1月，作者共完成了38例序贯旁路手术。这些手术包括30例与小腿动脉进行外周吻合的Y形移植手术、4例与足部动脉进行外周吻合的Y形移植手术和4例桥式移植手术。Y形移植是一种技术，即形成一个经典的远端旁路，然后另一个旁路以锐角端侧连接到该旁路。复合旁路形成一个倒置的字母Y。其远端分支与小腿或足部动脉吻合。桥式移植是一种技术，即使用去除瓣膜的静脉移植物在小腿动脉之间形成一个短旁路，允许双向血流。远端吻合为端侧吻合。所有上述血管重建手术均针对严重肢体缺血，部分患者有血管腔内再次干预史。在患者组中，20例重建手术使用了自体静脉，10例重建手术使用了聚四氟乙烯假体。出院时进行了临床和超声检查，随后在1、3、6和12个月进行复查。
Y形移植重建患者的随访期为6 - 20个月（平均时长12个月）。2例患者因旁路移植失败接受了大截肢手术，3例患者血管重建通畅出院，他们的死亡与手术无关。作者记录到4例旁路移植失败，但主干通畅。30天的初次/二次通畅率为90%/97%，长期通畅率为93%。
血管重建结果与文献报道相似。为了更准确地评估个体血管重建方案，需要进行长期随访研究，包括随机研究。
