Park Dae-Joon, Park Yang-Jin, Yoon Kyoung Won, Heo Seon-Hee, Kim Dong-Ik, Kim Young-Wook
Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Vasc Specialist Int. 2016 Dec;32(4):160-165. doi: 10.5758/vsi.2016.32.4.160. Epub 2016 Dec 31.
The superiority of autogenous vein conduits is well known in lower extremity arterial bypass (LEAB). Among various alternative conduits for LEAB, long-term results of arm vein grafts were investigated in this study.
We retrospectively reviewed clinical characteristics of 28 patients who underwent infrainguinal LEAB with autogenous arm vein grafts at a single institute between January 2003 and December 2015. All procedures were performed in the absence of adequate saphenous veins. Graft patency was determined by periodic examinations with duplex ultrasonography.
Autologous arm vein grafts were implanted for 28 patients (mean age, 60.4±16.8 years; range, 20-82 years; male, 92.9%; atherosclerosis, 19 [67.9%]; and non-atherosclerotic disease 9 [32.1%] including 5 patients with Buerger's disease). Source of arm vein were basilic 13 (46.4%), cephalic 4 (14.3%) and composition graft with other veins in 11 (39.3%) cases. The level of distal anastomosis was distributed as popliteal in 5 (17.9%), tibio-peroneal in 21 (75.0%) and inframalleolar artery in 2 (7.1%) cases. Mean duration of follow-up was 41.5±46.9 months (range, 1-138 months). Cumulative primary patency rates at 1, 3, and 5 years were 66.5%, 60.9% and 60.9%, respectively. Assisted-primary patency rates at 1, 3 and 5 years were 66.5%, 66.5% and 66.5%, respectively. Secondary patency rates at 1, 3 and 5 years were 70.8%, 70.8% and 70.8%, respectively. There was one limb amputation during the follow-up period.
Arm veins are a useful alternative conduit when great saphenous veins are not available during LEAB.
自体静脉导管在下肢动脉搭桥术（LEAB）中的优势是众所周知的。在LEAB的各种替代导管中，本研究调查了臂静脉移植物的长期效果。
我们回顾性分析了2003年1月至2015年12月期间在单一机构接受自体臂静脉移植物进行腹股沟下LEAB的28例患者的临床特征。所有手术均在没有足够大隐静脉的情况下进行。通过定期的双功超声检查确定移植物通畅情况。
28例患者植入了自体臂静脉移植物（平均年龄60.4±16.8岁；范围20 - 82岁；男性占92.9%；动脉粥样硬化患者19例[67.9%]；非动脉粥样硬化疾病患者9例[32.1%]，包括5例血栓闭塞性脉管炎患者）。臂静脉来源为贵要静脉13例（46.4%），头静脉4例（14.3%），11例（39.3%）为与其他静脉的复合移植物。远端吻合水平分布为腘动脉5例（17.9%），胫腓动脉21例（75.0%），内踝下动脉2例（7.1%）。平均随访时间为41.5±46.9个月（范围1 - 138个月）。1年、3年和5年的累积原发性通畅率分别为66.5%、60.9%和60.9%。1年、3年和5年的辅助原发性通畅率分别为66.5%、66.5%和66.5%。1年、3年和5年的继发性通畅率分别为70.8%、70.8%和70.8%。随访期间有1例肢体截肢。
当LEAB期间没有大隐静脉时，臂静脉是一种有用的替代导管。
