Avgerinos Efthymios D, Sachdev Ulka, Naddaf Abdallah, Doucet Dannielle R, Mohapatra Abhisekh, Leers Steven A, Chaer Rabih A, Makaroun Michel S
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
J Vasc Surg. 2015 Aug;62(2):385-91. doi: 10.1016/j.jvs.2015.03.025. Epub 2015 May 2.
There is a need to better define the role of alternative autologous vein (AAV) segments over contemporary prosthetic conduits in patients with critical limb ischemia when great saphenous vein (GSV) is not available for use as the bypass conduit.
Consecutive patients who underwent bypass to infrageniculate targets between 2007 and 2011 were categorized in three groups: GSV, AAV, and prosthetic. The primary outcome was graft patency. The secondary outcome was limb salvage. Cox proportional hazards regression was used to adjust for baseline confounding variables.
A total of 407 infrainguinal bypasses to below-knee targets were analyzed; 255 patients (63%) received a single-segment GSV, 106 patients (26%) received an AAV, and 46 patients (11%) received a prosthetic conduit. Baseline characteristics were similar among groups, with the exception of popliteal targets and anticoagulation use being more frequent in the prosthetic group. Primary patency at 2 and 5 years was estimated at 47% and 32%, respectively, for the GSV group; 24% and 23% for the AAV group; and 43% and 38% for the prosthetic group. Primary assisted patency at 2 and 5 years was estimated at 71% and 55%, respectively, for the GSV group; 53% and 51% for the AAV group; and 45% and 40% for the prosthetic group. Secondary patency at 2 and 5 years was estimated at 75% and 60%, respectively, for the GSV group; 57% and 55% for the AAV group; and 46% and 41% for the prosthetic group. In Cox analysis, primary patency (hazard ratio [HR], 0.55; P < .001; 95% confidence interval [CI], 0.404-0.758), primary assisted patency (HR, 0.57; P = .004; 95% CI, 0.388-0.831), and secondary patency (HR, 0.56; P = .005; 95% CI, 0.372-0.840) were predicted by GSV compared with AAV, but there was no difference between AAV and prosthetic grafts except for the primary patency, for which prosthetic was protective (HR, 0.38; P < .001; 95% CI, 0.224-0.629). Limb salvage was similar among groups.
AAV conduits may not offer a significant patency advantage in midterm follow-up over prosthetic bypasses.
对于严重肢体缺血患者，当大隐静脉（GSV）无法用作旁路移植血管时，有必要更好地明确替代自体静脉（AAV）段相对于当代人工血管的作用。
将2007年至2011年间接受膝下目标血管旁路移植术的连续患者分为三组：GSV组、AAV组和人工血管组。主要结局指标为移植血管通畅率。次要结局指标为肢体挽救情况。采用Cox比例风险回归分析对基线混杂变量进行校正。
共分析了407例膝下目标血管的腹股沟下旁路移植术；255例患者（63%）接受单段GSV移植，106例患者（26%）接受AAV移植，46例患者（11%）接受人工血管移植。各组间基线特征相似，但人工血管组腘动脉目标血管及抗凝药物使用更为频繁。GSV组2年和5年的初始通畅率分别估计为47%和32%；AAV组为24%和23%；人工血管组为43%和38%。GSV组2年和5年的初始辅助通畅率分别估计为71%和55%；AAV组为53%和51%；人工血管组为45%和40%。GSV组2年和5年的二次通畅率分别估计为75%和60%；AAV组为57%和55%；人工血管组为46%和41%。在Cox分析中，与AAV相比，GSV可预测初始通畅率（风险比[HR]，0.55；P <.001；95%置信区间[CI]，0.404 - 0.758）、初始辅助通畅率（HR，0.57；P =.004；95% CI，0.388 - 0.831）和二次通畅率（HR，0.56；P =.005；95% CI，0.372 - 0.840），但除初始通畅率外，AAV与人工血管移植之间无差异，人工血管移植在初始通畅率方面具有保护作用（HR，0.38；P <.001；95% CI，0.224 - 0.629）。各组间肢体挽救情况相似。
在中期随访中，AAV血管移植相对于人工血管旁路移植可能没有显著的通畅优势。
