Perler B A, Osterman F A, Mitchell S E, Burdick J F, Williams G M
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
J Cardiovasc Surg (Torino). 1990 Sep-Oct;31(5):656-61.
Although infra-inguinal autogenous vein graft stenoses may be treated by balloon dilatation (PTA) or surgical revision, the optimal approach is undefined. Over the last 7 years 24 PTA procedures were performed on 37 vein graft stenoses in 19 grafts. Graft stenoses were diagnosed from 2 to 72 (mean = 17.3) months after implantation. PTA was successfully completed in 23 (96%) of the 24 procedures including 18 (95%) of the primary, and 5 (100%) of the secondary procedures. Recurrent vein graft stenosis or graft thrombosis developed in 12 (67%) grafts from 3 to 47 (mean = 12.5) months after primary PTA. Long-term patency after primary PTA was 69% at 6, 29% at 12, and 22% at 36 months; secondary patency was 81% at 6, 45% at 12, and 27% at 36 months. During the same period vein graft stenosis in 7 fem-pop and 2 fem-tib grafts were surgically revised with an initial success rate of 100%, and 2 (22%) complications. Four (44%) of these grafts occluded from 1-17 (mean 6.2) months after repair, yielding a primary 5-year patency of 62%. Although vein graft stenosis may be safely, effectively, and repeatedly treated with PTA, long-term durability appears to be superior after surgical revision.
尽管腹股沟下自体静脉移植血管狭窄可通过球囊扩张术（PTA）或手术修复来治疗，但最佳方法尚未明确。在过去7年中，对19根移植血管中的37处静脉移植血管狭窄进行了24次PTA手术。移植血管狭窄在植入后2至72个月（平均17.3个月）被诊断出来。24次手术中有23次（96%）成功完成了PTA，包括18次初次手术中的17次（95%）和5次二次手术中的5次（100%）。初次PTA后3至47个月（平均12.5个月），12根（67%）移植血管出现了复发性静脉移植血管狭窄或移植血管血栓形成。初次PTA后的长期通畅率在6个月时为69%，12个月时为29%，36个月时为22%；二次通畅率在6个月时为81%，12个月时为45%，36个月时为27%。在同一时期，对7根股-腘和2根股-胫移植血管的静脉移植血管狭窄进行了手术修复，初始成功率为100%，有2例（22%）并发症。其中4根（44%）移植血管在修复后1至17个月（平均6.2个月）闭塞，5年的初次通畅率为62%。尽管静脉移植血管狭窄可以通过PTA安全、有效且反复地进行治疗，但手术修复后的长期耐久性似乎更好。
