Rutherford R B, Sawyer J D, Jones D N
University of Colorado Health Sciences Center, Denver.
J Vasc Surg. 1990 Oct;12(4):422-6; discussion 426-8.
Duplex scanning was used to study residual greater and lesser saphenous vein segments in 14 limbs with previous partial distal greater saphenous vein removal, 19 limbs with partial proximal greater saphenous vein removal, 29 limbs with total greater saphenous vein removal, 10 limbs with high greater saphenous vein ligation, as well as 37 contralateral unoperated and 8 other normal limbs. Partial distal removal showed better preservation of residual greater saphenous vein than partial proximal removal, with greater preservation of "usable" length and greater average diameter. Compared to contralateral unoperated legs, partial distal removal, partial proximal removal, and total removal all showed a similar degree of compensatory lesser saphenous vein enlargement. High ligation showed no lesser saphenous vein enlargement but showed the best greater saphenous vein preservation, none had less than 85% preservation of potential length. Combining residual greater saphenous vein and lesser saphenous vein segments of usable caliber, 100% of high ligation, 93% of partial distal removal, and 74% of partial proximal removal had greater than 60 cm total length, and most total removal had greater than 40 cm usable residual lesser saphenous vein. Previous saphenous vein surgery should not categorically exclude patients as having no usable residual ipsilateral vein for bypass. Partial distal removal allows better preservation of length and caliber of residual greater saphenous vein than proximal harvest, with both showing equivalent lesser saphenous vein enlargement to those with total greater saphenous vein removal. High ligation, performed for early tributary varicosities, in patients with saphenofemoral but no perforator incompetence, gives excellent preservation of residual greater saphenous vein length and caliber. Sclerotherapy to tributary varicosities did not obliterate distal greater saphenous vein segments.
采用双功扫描研究了14例先前进行过大隐静脉远端部分切除的肢体、19例大隐静脉近端部分切除的肢体、29例大隐静脉完全切除的肢体、10例大隐静脉高位结扎的肢体以及37例对侧未手术肢体和8例其他正常肢体中的大隐静脉和小隐静脉残余段。大隐静脉远端部分切除显示残余大隐静脉的保留情况优于近端部分切除，“可用”长度保留更多，平均直径更大。与对侧未手术的腿相比，大隐静脉远端部分切除、近端部分切除和完全切除均显示出相似程度的小隐静脉代偿性扩张。高位结扎未显示小隐静脉扩张，但显示大隐静脉保留情况最佳，无一例潜在长度保留少于85%。将具有可用管径的残余大隐静脉和小隐静脉段相结合，100%的高位结扎、93%的远端部分切除和74%的近端部分切除总长度大于60 cm，大多数完全切除的患者有大于40 cm的可用残余小隐静脉。先前的隐静脉手术不应绝对排除患者没有可用的同侧残余静脉用于搭桥。大隐静脉远端部分切除比近端采集能更好地保留残余大隐静脉的长度和管径，两者均显示出与大隐静脉完全切除患者等效的小隐静脉扩张。对于有隐股静脉瓣膜功能不全但无穿通支功能不全的患者，为早期分支静脉曲张进行的高位结扎能出色地保留残余大隐静脉的长度和管径。对分支静脉曲张进行硬化治疗并未闭塞大隐静脉远端段。
