Tishchenko I S, Zolkin V N, Maksimov N V, Korotkov I N, Demidov I Yu, Barzaeva M A
Department of Vascular Surgery, Municipal Clinical Hospital No 57, Moscow, Russia.
Angiol Sosud Khir. 2016;22(4):130-135.
The authors analysed two-year results of inftrainguinal distal arterial reconstructions using xenograft ("kemAngioprosthesis") as compared with an autovein. Ours was a retrospective study including a total of 110 patients who endured 57 femoropopliteal (distal) and 54 femorotibial bypasses by means of both an autovein and a xenograft used as a shunt. The indications for reconstructive operation in the majority of cases was critical ischaemia induced by an atherosclerotic lesion of the femoropoplitealtibial segment corresponding to type D according to the TASC II classification. A xenograft was used only in case when the patient had neither great nor small saphenous vein suitable for use. Xenografts were used in 38 operations. In femoropopliteal (distal) bypasses the primary two-year patency of the xenograft virtually did not differ from that of autovenous shunts (70.1 and 76.5%, respectively). The two-year limb salvage rate for xenografts and autoveins used as shunts amounted to 87.1 and 88.7%, respectively. In For femorotibial bypass grafting, primary 2-year patency of xenografts was considerably worse and amounted to 35.8 versus 73.7% for autovenous shunts. The two-year limb salvage rate did not depend upon the type of the shunt, amounting in both cases to 80.2%. A characteristic complication for using xenografts was aneurysmatic degeneration of the shunts, which was observed in 21% of cases averagely 2 years after surgery. A conclusion was made that using xenografts for infrainguinal bypass operations may be considered as an adequate alternative in case of no autovenous material available.
作者分析了使用异种移植物(“kem血管假体”)与自体静脉进行腹股沟下远端动脉重建的两年结果。我们进行的是一项回顾性研究,共纳入110例患者,他们接受了57例股腘(远端)和54例股胫旁路手术,分别使用自体静脉和异种移植物作为分流材料。大多数病例中重建手术的指征是根据TASC II分类法,由股腘胫段动脉粥样硬化病变引起的严重缺血,属于D型。仅在患者没有适合使用的大隐静脉或小隐静脉时才使用异种移植物。在38例手术中使用了异种移植物。在股腘(远端)旁路手术中,异种移植物的两年初始通畅率与自体静脉分流术的通畅率实际上没有差异(分别为70.1%和76.5%)。用作分流材料的异种移植物和自体静脉的两年肢体挽救率分别为87.1%和88.7%。在股胫旁路移植术中,异种移植物的两年初始通畅率明显更差,为35.8%,而自体静脉分流术为73.7%。两年肢体挽救率不取决于分流材料的类型,两种情况均为80.2%。使用异种移植物的一个典型并发症是分流物的动脉瘤样变性,平均在术后2年的病例中观察到21%。得出的结论是,在没有自体静脉材料可用的情况下,使用异种移植物进行腹股沟下旁路手术可被视为一种合适的替代方法。