Nierlich Patrick, Enzmann Florian K, Dabernig Werner, San Martin Julio Ellacuriaga, Akhavan Fatema, Linni Klaus, Hölzenbein Thomas
Department of Vascular and Endovascular Surgery, University Hospital Salzburg, Salzburg, Austria.
Department of Vascular and Endovascular Surgery, University Hospital Salzburg, Salzburg, Austria.
Ann Vasc Surg. 2019 Oct;60:264-269. doi: 10.1016/j.avsg.2019.02.015. Epub 2019 May 7.
Bypass in the upper extremity is a rare procedure mainly performed for chronic ischemia, trauma, or hemodialysis access complications. Feasibility and success of use of the arm vein and small saphenous vein (SSV) for autologous vein bypass have been reported in peripheral artery bypass procedures. There are very few reports on the use of alternative veins in upper extremity bypass. We report our experience with arm vein and SSV as a graft source in upper extremity arterial disease.
Retrospective analysis of a consecutively collected case series in an academic tertiary referral center from January 2010 to February 2018. Study end points were primary patency, secondary patency, limb salvage, and survival.
In total, 47 patients were treated with upper extremity bypass either using the SSV (n = 17) or arm veins (n = 30). Indications were either acute (n = 12) or chronic ischemia (n = 35) caused by acute (n = 8) and chronic (n = 9) trauma, sequela of iatrogenic interventions (n = 4), peripheral artery disease (n = 14), thrombangiitis obliterans (n = 3), and dialysis-access-related complications (n = 9). An arm vein was used in 30 and the SSV in 17 patients. Primary patency after 12 months was 87% with the SSV and 75% with an arm vein (P = 0.8) and 63% and 75% after 36 months (P = 0.9). Secondary patency were 100% with an arm vein and 100% with the SSV after 36 months (P = 0.4). One patient had to undergo major amputation and 2 minor amputations.
Arm vein revascularization using the primarily arm vein or SSV as a bypass conduit can be performed with reasonable mortality and morbidity rates and provide good results comparable with the greater saphenous vein.
上肢血管搭桥术是一种罕见的手术，主要用于治疗慢性缺血、创伤或血液透析通路并发症。在周围动脉搭桥手术中，已有关于使用臂静脉和小隐静脉（SSV）进行自体静脉搭桥的可行性和成功率的报道。关于在上肢搭桥手术中使用替代静脉的报道非常少。我们报告了我们使用臂静脉和SSV作为上肢动脉疾病移植物来源的经验。
对2010年1月至2018年2月在一家学术三级转诊中心连续收集的病例系列进行回顾性分析。研究终点为原发性通畅率、继发性通畅率、肢体挽救率和生存率。
共有47例患者接受了上肢搭桥手术，其中使用SSV的有17例，使用臂静脉的有30例。手术指征包括急性（n = 12）或慢性缺血（n = 35），其由急性（n = 8）和慢性（n = 9）创伤、医源性干预后遗症（n = 4）、外周动脉疾病（n = 14）、血栓闭塞性脉管炎（n = 3）和透析通路相关并发症（n = 9）引起。30例患者使用了臂静脉，17例患者使用了SSV。12个月时，SSV组的原发性通畅率为87%，臂静脉组为75%（P = 0.8）；36个月时，分别为63%和75%（P = 0.9）。36个月时，臂静脉组和SSV组的继发性通畅率均为100%（P = 0.4）。1例患者不得不接受大截肢手术，2例接受小截肢手术。
使用主要的臂静脉或SSV作为搭桥管道进行臂静脉血运重建，死亡率和发病率合理，效果良好，可与大隐静脉相媲美。
