Taylor L M, Edwards J M, Porter J M
Department of Surgery, Oregon Health Sciences University, Portland 97201-3098.
J Vasc Surg. 1990 Feb;11(2):193-205; discussion 205-6. doi: 10.1067/mva.1990.17235.
From January 1980 through December 1988, 564 limbs in 434 patients were treated for infrainguinal arterial ischemia. Of these, 516 limbs in 387 patients underwent reversed vein bypass grafting. The remainder were treated by primary amputation (11 limbs, 1.9%) or by prosthetic bypass (37 limbs, 6.4%). The indications for operation were limb salvage in 80% of limbs and claudication in 20%. Adequate ipsilateral greater saphenous vein was available for 285 (55%) grafts, with reversed vein bypass achieved in the other 231 operations by use of distal graft origins (151 grafts), use of alternate vein sources (120 grafts), and splicing of venous segments (81 grafts). Seventy-six grafts (15%) were to the above-knee popliteal artery, 199 grafts (37%) were to the below-knee popliteal artery, and 241 grafts (47%) were to infrapopliteal arteries, 26 of which (11%) were to inframalleolar arteries. The primary and secondary patencies for all grafts at 5 years were 75% and 81%, respectively. Grafts to infrapopliteal arteries had significantly worse primary patency (69%) at 5 years than did grafts to the popliteal artery (77%, above knee; 80%, below knee) and grafts formed of adequate ipsilateral greater saphenous vein had significantly better primary patency (80%) than did grafts performed when this conduit was not available (68%). Secondary patency of all graft categories ranged from 76% to 85%, and there were no significant differences regardless of site of distal anastomosis, source of venous conduit, or site of graft origins. We prefer the use of reversed vein bypass grafting for lower extremity revascularization both because of the excellent patency results and because the technique can be applied to the larger number of patients in our practice who lack intact ipsilateral greater saphenous vein, in contrast to in situ vein bypass procedures.
1980年1月至1988年12月，434例患者的564条肢体接受了股动脉以下动脉缺血的治疗。其中，387例患者的516条肢体接受了静脉转流移植术。其余患者接受了一期截肢（11条肢体，1.9%）或人工血管转流术（37条肢体，6.4%）。手术指征为80%的肢体保肢和20%的间歇性跛行。285例（55%）移植手术有足够的同侧大隐静脉可用，在另外231例手术中，通过使用远端移植血管起始处（151例移植）、使用替代静脉来源（120例移植）和拼接静脉段（81例移植）实现了静脉转流移植。76例（15%）移植血管至腘动脉膝上部分，199例（37%）至腘动脉膝下部分，241例（47%）至腘动脉以下动脉，其中26例（11%）至内踝下动脉。所有移植血管5年时的一期通畅率和二期通畅率分别为75%和81%。腘动脉以下动脉的移植血管5年时的一期通畅率（69%）明显低于腘动脉移植血管（膝上77%；膝下80%），并且由足够的同侧大隐静脉构成的移植血管的一期通畅率（80%）明显高于没有该血管时进行的移植血管（68%）。所有移植血管类别的二期通畅率在76%至85%之间，无论远端吻合部位、静脉管道来源或移植血管起始部位如何，均无显著差异。我们更倾向于使用静脉转流移植术进行下肢血管重建，这既是因为其出色的通畅率结果，也是因为与原位静脉转流手术相比，该技术可应用于我们实践中更多缺乏完整同侧大隐静脉的患者。
