Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
Eur J Vasc Endovasc Surg. 2014 Jun;47(6):609-14. doi: 10.1016/j.ejvs.2014.01.019. Epub 2014 Mar 6.
The value of alternative autogenous venous conduits for treating critical limb ischaemia (CLI) with infragenicular bypass surgery is well established. In this study, the results of using arm veins as alternative conduits for treating CLI over a 15-year period have been evaluated.
This was a retrospective study. Between 1991 and 2005. 120 infragenicular bypasses using arm vein conduits (AVCs) were performed in 120 patients. CLI was the main indication (87.5%) for the procedures. The indications for using arm veins were inadequacy or absence of the ipsilateral greater saphenous vein (GSV). Survival, limb salvage, and patency rates were calculated using the Kaplan-Meier method.
There was a predominance of male gender (65%), and the group mean age was 68.1 ± 8.3 years. The mean follow-up period was 29.6 ± 26.3 months. The operative mortality (30 days) rate was 7.5%. The main alternative conduit was non-spliced cephalic vein (37.5%). Composite grafts included GSV + AVC (45.2%), AVC + AVC (43.3%) and small saphenous vein + AVC (11.5%). The 5-year primary and secondary patency (SP) rates were 45.2 ± 5.6% and 56.5 ± 5.0%, respectively. The 5-year SP rate was greatest when using non-spliced cephalic vein (65.8 ± 7.6%), but there was no difference in cumulative patency between spliced and non-spliced veins (49.5 ± 8.0% vs. 61.2 ± 6.4%; p = 0.501). The 5-year limb salvage and survival rates were 70.6 ± 5.9% and 59.6 ± 5.8%, respectively.
The favourable long term results of secondary patency and limb salvage rates encourage the use of arm veins as alternative conduits for infragenicular bypass surgery.
替代自体静脉在治疗膝下旁路手术的严重肢体缺血（CLI）中的价值已得到充分证实。在这项研究中，评估了使用手臂静脉作为替代导管治疗 CLI 超过 15 年的结果。
这是一项回顾性研究。1991 年至 2005 年期间，120 例 CLI 患者共进行了 120 例膝下旁路手术，使用手臂静脉导管（AVC）。CLI 是手术的主要适应证（87.5%）。使用手臂静脉的适应证是同侧大隐静脉（GSV）不足或缺失。使用 Kaplan-Meier 方法计算生存率、肢体存活率和通畅率。
该组以男性为主（65%），平均年龄为 68.1±8.3 岁。平均随访时间为 29.6±26.3 个月。手术死亡率（30 天）为 7.5%。主要替代导管为非拼接头静脉（37.5%）。复合移植物包括 GSV+AVC（45.2%）、AVC+AVC（43.3%）和小隐静脉+AVC（11.5%）。5 年原发和继发通畅率（SP）分别为 45.2±5.6%和 56.5±5.0%。使用非拼接头静脉时，5 年 SP 率最高（65.8±7.6%），但拼接和非拼接静脉的累积通畅率无差异（49.5±8.0%比 61.2±6.4%；p=0.501）。5 年肢体存活率和生存率分别为 70.6±5.9%和 59.6±5.8%。
良好的长期通畅率和肢体存活率结果鼓励使用手臂静脉作为膝下旁路手术的替代导管。
