Belkin M, Donaldson M C, Whittemore A D, Polak J F, Grassi C J, Harrington D P, Mannick J A
Department of Surgery and Radiology, Brigham and Women's Hospital, Boston, MA 02115.
J Vasc Surg. 1990 Feb;11(2):289-94; discussion 295-6. doi: 10.1067/mva.1990.17565.
Vein graft failure remains a major challenge for the vascular surgeon. Thrombolysis of occluded vein grafts has shown promising short-term results in restoring vein graft patency, however, the long-term results are not established. This study examines the long-term patency and limb salvage after successful thrombolysis and revision of 22 thrombosed vein grafts in 21 patients. There were 17 men and four women with an average age of 60 years (38 to 77 years). Failed vein grafts had an average primary patency of 19 months (1 to 84 months) and included eight in situ grafts and 14 non-in situ grafts. Twelve grafts were to the popliteal level, whereas 10 were infrapopliteal. Thrombolytic agents used included urokinase (15), tissue plasminogen activator (5), and streptokinase (2). After successful thrombolysis, 19 grafts underwent 26 additional procedures including percutaneous transluminal angioplasty (9), vein patch angioplasty (4), vein interposition or jump extension graft (9), or other procedures (4). Three patients had no additional procedure, but one was placed on sodium warfarin (Coumadin). After successful initial vein graft salvage, life-table analysis revealed a 36.6% +/- 11.9% patency at 1 year and a 22.9% +/- 11.6% patency at 3 years. After secondary failure six patients had further interventions contributing to an improved limb salvage of 66.9% +/- 11.6% at 1 year and 60.3% +/- 19.0% at 3 years. The results suggest that thrombosed vein grafts initially salvaged with thrombolysis and revision do not have a favorable long-term patency, and that a premium must be placed on the detection of the failing vein graft before thrombosis.
静脉移植物失败仍然是血管外科医生面临的一项重大挑战。对闭塞的静脉移植物进行溶栓治疗在恢复静脉移植物通畅方面已显示出有希望的短期结果，然而，长期结果尚未明确。本研究调查了21例患者中22条血栓形成的静脉移植物成功溶栓和修复后的长期通畅率及肢体挽救情况。其中男性17例，女性4例，平均年龄60岁（38至77岁）。失败的静脉移植物平均初始通畅时间为19个月（1至84个月），包括8条原位移植物和14条非原位移植物。12条移植物至腘动脉水平，而10条位于腘动脉以下。使用的溶栓剂包括尿激酶（15例）、组织纤溶酶原激活剂（5例）和链激酶（2例）。成功溶栓后，19条移植物又接受了26次额外手术，包括经皮腔内血管成形术（9例）、静脉补片血管成形术（4例）、静脉间置或跳跃延伸移植物（9例）或其他手术（4例）。3例患者未进行额外手术，但1例患者服用了华法林钠（香豆素）。在成功进行初始静脉移植物挽救后，寿命表分析显示1年时通畅率为36.6%±11.9%，3年时为22.9%±11.6%。继发失败后，6例患者接受了进一步干预，使1年时肢体挽救率提高至66.9%±11.6%，3年时为60.3%±19.0%。结果表明，最初通过溶栓和修复挽救的血栓形成静脉移植物长期通畅情况不佳，必须高度重视在血栓形成前检测出功能逐渐丧失的静脉移植物。
