Ferretto Luca, Piazza Michele, Bonvini Stefano, Battocchio Piero, Grego Franco, Ricotta Joseph J
Clinic of Vascular and Endovascular Surgery, Padova University, School of Medicine, Padova, Italy.
Ann Vasc Surg. 2012 Jan;26(1):34-9. doi: 10.1016/j.avsg.2011.07.003. Epub 2011 Oct 22.
To describe early results of a novel technique (ViPS, Viabahn Padova Sutureless) that connects a vascular prosthetic graft to a target artery in a sutureless fashion.
A consecutive series of five patients with peripheral arterial occlusive disease (Rutherford class IV and V) underwent six ViPS procedures (one bilateral) for limb revascularization. Angiography in all cases demonstrated complete superficial femoral artery (SFA) occlusion with reconstitution of a circumferentially calcified above-knee popliteal artery. Ultrasonography revealed no adequate vein for autogenous bypass creation. In all cases, a previous attempt of SFA endovascular recanalization was unsuccessful. A Viabahn (W.L. Gore, Flagstaff, AZ) endoprosthesis was partially deployed, and its proximal end was sutured to a polytetrafluoroethylene graft. After surgical exposure, the circumferentially calcified popliteal artery, which could not be safely sutured, was transected and the undeployed distal portion of the Viabahn was inserted into the popliteal artery supported by a stiff guidewire. The distal portion of the Viabahn graft was then deployed 2.5 cm into the popliteal artery with optimal apposition. The proximal end of the polytetrafluoroethylene graft was then sutured to the common femoral artery. The distal portion of the Viabahn was ballooned to ensure apposition with the popliteal artery.
The mean time for surgical modification of the device was 6.6 minutes with a mean time for ViPS anastomosis deployment of 7 seconds. Mean operative time for ViPS procedure was 61 minutes (range: 48-74). Completion angiogram in all cases demonstrated a patent graft with no sign of dissection. The patients' symptoms resolved in all cases, with complete ulcer healing occurring in five patients within 3 weeks. Follow-up imaging (mean = 2.6 months, range: 1-5) with eco-color-Doppler and computed tomography angiogram demonstrated a patent graft with no loss of device integrity in all cases.
The ViPS technique is simple, easily performed, and provides an alternative for bypass creation, particularly in cases where challenging arterial anastomoses are required. Furthermore, this technique has the potential to reduce operative time and is accomplished using common commercially available devices.
描述一种新型技术（ViPS，威博恩帕多瓦无缝合技术）以无缝合方式将血管假体移植物连接至目标动脉的早期结果。
连续5例外周动脉闭塞性疾病（卢瑟福分级IV级和V级）患者接受了6次ViPS手术（1例双侧手术）以实现肢体血运重建。所有病例的血管造影均显示股浅动脉完全闭塞，膝上腘动脉呈环形钙化且有再通。超声检查显示无足够的自体静脉用于搭桥。所有病例中，先前尝试的股浅动脉血管腔内再通均未成功。将一个威博恩（W.L. Gore公司，弗拉格斯塔夫，亚利桑那州）血管内假体部分展开，其近端缝合至聚四氟乙烯移植物。手术暴露后，无法安全缝合的环形钙化腘动脉被切断，威博恩未展开的远端部分在一根硬导丝支撑下插入腘动脉。然后将威博恩移植物的远端在腘动脉内展开2.5厘米并实现最佳贴合。接着将聚四氟乙烯移植物的近端缝合至股总动脉。威博恩的远端部分进行球囊扩张以确保与腘动脉贴合。
装置手术调整的平均时间为6.6分钟，ViPS吻合展开的平均时间为7秒。ViPS手术的平均手术时间为61分钟（范围：48 - 74分钟）。所有病例的完成血管造影均显示移植物通畅，无夹层迹象。所有病例中患者症状均缓解，5例患者在3周内溃疡完全愈合。采用彩色多普勒超声和计算机断层血管造影进行的随访成像（平均 = 2.6个月，范围：1 - 5个月）显示所有病例中移植物通畅，装置完整性无损失。
ViPS技术简单、易于实施，为搭桥手术提供了一种替代方法，特别是在需要进行具有挑战性的动脉吻合的情况下。此外，该技术有可能缩短手术时间，并且使用常见的市售装置即可完成。
