McCallum John C, Bensley Rodney P, Darling Jeremy D, Hamdan Allen D, Wyers Mark C, Hile Chantel, Guzman Raul J, Schermerhorn Marc L
Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
J Vasc Surg. 2016 Jan;63(1):142-7. doi: 10.1016/j.jvs.2015.08.065. Epub 2015 Oct 17.
Lower extremity bypass grafts that develop stenoses are commonly treated with either open surgical or endovascular revision. Vein graft stenoses with unfavorable lesions (multiple lesions, lesions >2 cm in length, lesions in grafts <3 months old, lesions in grafts <3 mm in diameter) fare worse than those with favorable lesions when treated with endovascular therapy. However, it is not known if unfavorable lesions fare better with surgical revision than with endovascular treatment or than favorable lesions treated with surgery.
We performed a retrospective review of 175 vein graft revisions performed at a single institution from 2000 to 2010. Characteristics of lesions treated with surgical and endovascular revision were identified. Cox proportional hazard models were used to identify predictors of revision failure (restenosis >75%, revision, or amputation).
Ninety-one failing vein grafts (52%) were treated with surgical revision and 84 with endovascular treatment (48%), with a median follow-up of 30 months. Favorable lesions fared better than unfavorable lesions after endovascular treatment, with 12-month freedom from failure of 59% vs 34% (P < .01), but not after surgical revision (66% vs 62%; P = .90). Unfavorable lesions had better freedom from failure after surgery than endovascular treatment (62% vs 34%; P < .01), and results in favorable lesions were similar (66% vs 59%; P = .57).
For the treatment of failing vein grafts, endovascular therapy appears adequate for favorable lesions and surgical revision is more durable for unfavorable lesions.
发生狭窄的下肢搭桥移植物通常采用开放手术或血管腔内修复术进行治疗。与具有有利病变的静脉移植物狭窄相比，具有不利病变（多处病变、长度>2 cm的病变、<3个月龄移植物中的病变、直径<3 mm移植物中的病变）的静脉移植物在接受血管腔内治疗时预后更差。然而，尚不清楚具有不利病变的移植物接受手术修复是否比血管腔内治疗效果更好，或者是否比接受手术治疗的有利病变效果更好。
我们对2000年至2010年在单一机构进行的175例静脉移植物修复术进行了回顾性研究。确定了接受手术和血管腔内修复治疗的病变特征。使用Cox比例风险模型确定修复失败（再狭窄>75%、再次修复或截肢）的预测因素。
91例失败的静脉移植物（52%）接受了手术修复，84例接受了血管腔内治疗（48%），中位随访时间为30个月。血管腔内治疗后，具有有利病变的移植物比具有不利病变的移植物预后更好，12个月无失败率分别为59%和34%（P<.01），但手术修复后并非如此（66%对62%；P = 0.90）。具有不利病变的移植物手术后无失败率高于血管腔内治疗（62%对34%；P<.01），具有有利病变的移植物结果相似（66%对59%；P = 0.57）。
对于失败的静脉移植物治疗，血管腔内治疗似乎适用于具有有利病变的移植物，而手术修复对于具有不利病变的移植物更持久。
