Ricci M A, Graham A M, Symes J F
Department of Surgery, Royal Victoria Hospital, McGill University, Montreal, PQ.
Can J Surg. 1990 Jun;33(3):216-20.
Current controversy surrounding in-situ and reversed saphenous vein grafts prompted a review of 161 procedures performed between 1982 and 1987. Analysis was based on objective criteria recommended by the Society for Vascular Surgery/International Society for Cardiovascular Surgery (SVS/ISCVS) Committee on Reporting Standards. There were 92 in-situ bypasses, 42 to the popliteal artery below the knee, and 50 to tibial vessels; of 69 reversed vein grafts, the comparable figures were 51 and 18. Sixty-seven in-situ and 43 reversed grafts were done for foot salvage. The overall primary patency rate for in-situ grafts was 81.1% at 30 days, 77.0% at 1 year, 74.7% at 3 years and 59.8% at 5 years; corresponding reversed vein patency rates were 85.2%, 76.8%, 67.0% and 42.3%. Patency rates for foot salvage for in-situ grafts were 81.7% at 1 month, 75.9% at 1 year and 72.6% at 3 years, and for reversed vein grafts 78.6%, 70.3% and 66.5%. Secondary patency rates were 72.8% at 3 years for in-situ vein and 67.2% for reversed vein; the foot-salvage rate at 3 years was 91.0% with in-situ vein and 78.9% with reversed vein. The study demonstrated no statistically significant difference between in-situ and reversed saphenous vein bypass for infrageniculate reconstruction, regardless of the distal anastomotic site or severity of disease. Although a trend favouring the in-situ technique was noted, particularly at the tibial level, longer follow-up and a prospective randomized trial is needed to evaluate this.
目前围绕原位和反转大隐静脉移植术的争议促使我们对1982年至1987年间进行的161例手术进行回顾。分析基于血管外科学会/国际心血管外科学会（SVS/ISCVS）报告标准委员会推荐的客观标准。有92例原位旁路手术，其中42例是在膝关节以下至腘动脉，50例是至胫血管；在69例反转静脉移植术中，相应数字分别为51例和18例。67例原位和43例反转移植术是为挽救足部而进行的。原位移植术的总体30天原发性通畅率为81.1%，1年时为77.0%，3年时为74.7%，5年时为59.8%；相应的反转静脉通畅率分别为85.2%、76.8%、67.0%和42.3%。原位移植术挽救足部的1个月通畅率为81.7%，1年时为75.9%，3年时为72.6%，反转静脉移植术的相应通畅率分别为78.6%、70.3%和66.5%。3年时原位静脉的继发性通畅率为72.8%，反转静脉为67.2%；3年时原位静脉的足部挽救率为91.0%，反转静脉为78.9%。该研究表明，对于膝下重建，无论远端吻合部位或疾病严重程度如何，原位和反转大隐静脉旁路手术之间在统计学上无显著差异。尽管注意到有一种倾向于原位技术的趋势，特别是在胫血管水平，但需要更长时间的随访和前瞻性随机试验来对此进行评估。
