Kabbani Loay, Escobar Guillermo A, Mansour Farah, Wakefield Thomas W, Henke Peter K
Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Ann Vasc Surg. 2011 May;25(4):496-501. doi: 10.1016/j.avsg.2011.02.002.
To assess the efficacy of axillary vein transplantation in the treatment of severe chronic venous insufficiency (CVI).
Among 139 complex venous reconstructions performed between 1991 and 2007 for CVI, 18 patients underwent upper extremity to lower extremity venous valve transplantation. An upper extremity valve was transplanted to the popliteal vein in 13 cases, to the common femoral vein in six cases, and to the saphenofemoral junction in two cases for a total of 21 procedures. All patients had follow-up with duplex scanning to assess valve competency and clinical visits to assess clinical improvement. Mean follow-up period was 37 months.
Mean patient age was 44 years, and 57% were men. Clinically, 57% of the limbs were Clincal (C) class C5-C6. The mean preoperative venous disability score was 2.95. Most of the patients (66%) had post-thrombotic valvular dysfunction. At the time of valve transplantation, there was no proximal venous obstruction documented. A successful operation was defined as a competent valve at the end of the procedure and was achieved in 20 of 21 (95%) patients. Eight patients had at least one postoperative complication, primarily bleeding. The mean postoperative venous disability score was 2.65 and this increased to 2.75 (p = not significant as compared with baseline) at the last postoperative visit. Median time to return of symptoms was 12 months, and median reflux-free survival period was 15 months.
Despite initial technical and symptomatic success with venous valve transplantation, there is a poor long-term valve competency rate and symptomatic control. These data suggest that a better understanding and therapy for severe CVI associated with valvular incompetence needs to be found.
评估腋静脉移植治疗严重慢性静脉功能不全（CVI）的疗效。
在1991年至2007年间为CVI进行的139例复杂静脉重建手术中，18例患者接受了上肢至下肢静脉瓣膜移植。13例患者将上肢瓣膜移植至腘静脉，6例移植至股总静脉，2例移植至大隐静脉-股静脉交界处，共进行了21次手术。所有患者均接受双功超声扫描随访以评估瓣膜功能，并接受临床检查以评估临床改善情况。平均随访期为37个月。
患者平均年龄为44岁，57%为男性。临床上，57%的肢体为临床（C）C5 - C6级。术前静脉功能障碍平均评分为2.95。大多数患者（66%）存在血栓形成后瓣膜功能障碍。在瓣膜移植时，未发现近端静脉阻塞。成功的手术定义为手术结束时瓣膜功能良好，21例患者中有20例（95%）达到这一标准。8例患者至少出现一种术后并发症，主要为出血。术后静脉功能障碍平均评分为2.65，在最后一次术后随访时升至2.75（与基线相比，p无显著性差异）。症状复发的中位时间为12个月，无反流生存期的中位时间为15个月。
尽管静脉瓣膜移植在技术和症状缓解方面取得了初步成功，但长期瓣膜功能良好率和症状控制情况较差。这些数据表明，需要找到对与瓣膜功能不全相关的严重CVI的更好理解和治疗方法。
