Kim Hyo-Sin, Seo Hong Joo, Chang Jeong Hwan
Department of Surgery Chosun University School of Medicine, Gwangju.
Department of Thoracic and Cardiovascular Surgery, Chosun University School of Medicine, Gwangju, Korea.
Vasc Specialist Int. 2014 Mar;30(1):26-32. doi: 10.5758/vsi.2014.30.1.26. Epub 2014 Mar 30.
Since the introduction of short vein bypass (SVB), many have reported its feasibility when long vein bypass (LVB) cannot be performed due to limited vein conduit. However, the presence of inflow-vessel disease may affect graft patency and thus require endovascular treatment prior to surgery. Our study aims to analyze the results between SVB and LVB.
From 2009 to 2013, 27 bypass procedures were reviewed retrospectively. Outcomes such as patency rate, postoperative ankle brachial index (ABI) and limb salvage rate between SVB and LVB were compared. Wound healing time and primary patency rate were analyzed and the former was also analyzed according to the respective angiosome and revascularization type.
There were 11 males and 16 females and the mean age was 66.6±12.3 years. Twenty four patients had TransAtlantic Inter-Society Consensus (TASC) D and 3 patients had TASC C lesions below knee. The 1-year cumulative patency rate between SVB and LVB were 63% and 66%, P=0.627. The limb salvage rate (100% vs. 73%; P=0.280) and postoperative ABI (0.592 vs. 0.508; P=0.620) were higher in the SVB group than in the LVB group, although the differences were not significant. There was no difference in wound healing time by angiosomal revascularization type. In situ vein graft showed higher patency rate than reversed greater saphenous vein (75% vs. 61%; P=0.00).
The results of SVB were similar to those of LVB. SVB is feasible in the setting of limited conduit availability, in combination with endovascular treatment in the presence of proximal lesions.
自短静脉搭桥术（SVB）引入以来，许多人报道了在因静脉导管有限而无法进行长静脉搭桥术（LVB）时其具有可行性。然而，流入血管疾病的存在可能会影响移植物通畅率，因此手术前需要进行血管内治疗。我们的研究旨在分析SVB和LVB之间的结果。
回顾性分析2009年至2013年期间的27例搭桥手术。比较了SVB和LVB之间的通畅率、术后踝肱指数（ABI）和肢体挽救率等结果。分析了伤口愈合时间和一期通畅率，并根据各自的血管体和血运重建类型对前者进行了分析。
男性11例，女性16例，平均年龄66.6±12.3岁。24例患者有跨大西洋跨学会共识（TASC）D级病变，3例患者有膝关节以下的TASC C级病变。SVB和LVB之间的1年累积通畅率分别为63%和66%，P = 0.627。SVB组的肢体挽救率（100%对73%；P = 0.280）和术后ABI（0.592对0.508；P = 0.620）高于LVB组，尽管差异不显著。血管体血运重建类型对伤口愈合时间没有影响。原位静脉移植物的通畅率高于大隐静脉反转术（75%对61%；P = 0.00）。
SVB的结果与LVB相似。在导管可用性有限的情况下，SVB是可行的，对于近端病变可结合血管内治疗。
