Michaels J A
Department of Surgery, University College and Middlesex School of Medicine, London, UK.
Br J Surg. 1989 Jan;76(1):7-14. doi: 10.1002/bjs.1800760105.
Autogenous saphenous vein is generally considered to be the best material for arterial bypass grafts below the inguinal ligament. Recent results have suggested that the advantage of vein over prosthesis is more pronounced in a distal situation, but it is not immediately apparent whether the difference is sufficient to justify a policy of using prosthesis for the initial above-knee graft to preserve the vein in case later surgery is required. An attempt has been made to answer this question. The literature has been reviewed to obtain estimates of the patency rates for grafts in different situations and a mathematical model has been set up using these figures to predict the outcome of different treatment policies. The model can be used to predict the result of alteration or inaccuracy in the data or to make use of the results of newly reported studies. The model predicts that the use of prosthesis for an initial graft will reduce the overall patency and substantially increase the requirement for reoperation, even if the present data give a substantial overestimate of the advantages of vein above the knee.
自体隐静脉通常被认为是腹股沟韧带以下动脉搭桥移植物的最佳材料。最近的结果表明，在远端情况下，静脉相对于假体的优势更为明显，但这种差异是否足以证明在初次膝上移植时使用假体以保留静脉以备后续手术之需的策略是否合理，目前尚不清楚。为此进行了一次尝试以回答这个问题。已对文献进行综述，以获取不同情况下移植物通畅率的估计值，并利用这些数据建立了一个数学模型来预测不同治疗策略的结果。该模型可用于预测数据变化或不准确的结果，或利用新报告研究的结果。该模型预测，即使目前的数据大大高估了膝上静脉的优势，初次移植使用假体仍会降低总体通畅率，并大幅增加再次手术的需求。
