Department of Surgery, MFA at George Washington University, Washington, DC 20037, USA.
Eur J Vasc Endovasc Surg. 2012 Aug;44(2):177-82. doi: 10.1016/j.ejvs.2012.04.014. Epub 2012 May 15.
The endovascular first approach has led to increasing complexity for surgical bypass especially in those patients without autogenous conduit. The use of vein interposed at the distal anastomosis has been reported to improve the results of prosthetic grafts. This series expands our initial experience with the distal vein patch technique (DVP) reporting a larger cohort with enhanced follow-up.
A retrospective review of prospectively collected data was performed for distal bypasses from July 1995 to November 2008.
MATERIALS/METHODS: 1296 tibial bypasses were performed with 270 using the DVP technique. Patient demographics included; 49% diabetes, 20% chronic renal failure, 33% prior failed bypass. Indications for revascularization were claudication (9.3%), rest pain (27.8%), gangrene (22.2%), and non-healing ulceration (40.7%). Lack of vein for the bypass conduit resulted from previous failed grafts (55%), coronary bypass (18%), poor quality vein (23%), or prior vein stripping (8%). Follow-up ranged from 1 to 48 months with graft surveillance by pulse exam, ABI, and Duplex ultrasound. Primary patency and limb salvage ± SE were determined by Kaplan-Meier life-table analysis using Rutherford criteria.
Bypasses originated from the external iliac (29%), CFA (55%), SFA (13%), popliteal (1%), and prior grafts (2%). Recipient arteries were below knee popliteal (6%), anterior tibial (25%), posterior tibial (30%), and peroneal (39%). Perioperative graft failure occurred in 13 cases with a total of 41 graft failures leading to 39 major amputations. Primary graft patency from one to four years was 79.8%, 75.6% 65.9%, and 51.2%. Corresponding limb salvage rates were 80.6%, 78.0%, 75.7%, and 67.5%.
Although not addressed by a randomized trial, we believe this expanded series is a more accurate reflection of expected results confirming that the DVP bypass leads to reasonable long-term results for those challenging patients that require prosthetic distal bypass for lower extremity revascularization.
腔内治疗为首的方法导致了旁路手术的复杂性增加，特别是在那些没有自体移植物的患者中。在远端吻合口处使用静脉移植物的方法已经被报道可以改善人造移植物的结果。本系列报道了更大的队列和增强的随访结果，扩大了我们对远端静脉补片技术（DVP）的初始经验。
对 1995 年 7 月至 2008 年 11 月期间前瞻性收集的数据进行回顾性分析。
材料/方法：1296 例胫骨旁路手术中有 270 例采用 DVP 技术。患者的人口统计学特征包括：49%糖尿病、20%慢性肾功能衰竭、33%既往旁路手术失败。血管重建的指征是跛行（9.3%）、静息痛（27.8%）、坏疽（22.2%）和非愈合性溃疡（40.7%）。旁路血管移植物缺乏的原因是既往移植物失败（55%）、冠状动脉旁路移植术（18%）、静脉质量差（23%）或既往静脉剥脱术（8%）。随访时间为 1 至 48 个月，通过脉搏检查、ABI 和双功能超声进行移植物监测。主要通畅率和肢体存活率±SE 通过使用 Rutherford 标准的 Kaplan-Meier 生命表分析来确定。
旁路手术起源于髂外动脉（29%）、股总动脉（55%）、股浅动脉（13%）、腘动脉（1%）和既往移植物（2%）。受区动脉为膝下腘动脉（6%）、胫前动脉（25%）、胫后动脉（30%）和腓动脉（39%）。围手术期移植物失败发生在 13 例患者中，共有 41 例移植物失败导致 39 例主要截肢。1 至 4 年的原发性移植物通畅率分别为 79.8%、75.6%、65.9%和 51.2%。相应的肢体存活率分别为 80.6%、78.0%、75.7%和 67.5%。
尽管没有随机试验来解决这个问题，但我们相信这个扩展的系列更准确地反映了预期的结果，证实了 DVP 旁路对于那些需要人造远端旁路进行下肢血运重建的具有挑战性的患者，可以带来合理的长期结果。
