Peterkin G A, LaMorte W W, Menzoian J O
Division of Surgery, Boston University Medical School, MA.
Arch Surg. 1988 Oct;123(10):1199-201. doi: 10.1001/archsurg.1988.01400340025004.
Recent reports suggest that intraoperatively measured runoff resistance can identify patients destined for early graft failure. We measured runoff resistance in 80 consecutive patients who had undergone infrainguinal bypass surgery, and periodically assessed graft patency. There were 57 femoropopliteal bypass grafts and 23 infrapopliteal bypasses. After 3, 6, or 12 months, there was no significant difference in mean resistance between those grafts remaining patent and those that failed. Moreover, among patients with very high resistance (greater than 1.2 mm Hg/mL/min), 12 bypass grafts remained patent for more than one year. These results demonstrate that even patients with relatively high runoff resistance can undergo successful bypass grafting. Consequently, patients with measured or angiographic evidence of poor runoff should not be denied vascular reconstruction on this basis alone. We believe that graft failure is a multifactorial process in which the nature of the graft material, location of the distal anastomosis, runoff resistance, and a number of other factors are likely to play a role.
近期报告表明，术中测量的流出道阻力能够识别出注定早期移植物失败的患者。我们对80例连续接受股腘以下旁路手术的患者测量了流出道阻力，并定期评估移植物通畅情况。其中有57例股腘旁路移植物和23例腘以下旁路移植物。3个月、6个月或12个月后，通畅的移植物与失败的移植物之间的平均阻力无显著差异。此外，在阻力非常高（大于1.2 mmHg/mL/min）的患者中，12例旁路移植物保持通畅超过一年。这些结果表明，即使流出道阻力相对较高的患者也能成功进行旁路移植手术。因此，仅凭测量或血管造影显示流出道不佳的证据，不应拒绝为患者进行血管重建。我们认为移植物失败是一个多因素过程，其中移植物材料的性质、远端吻合口的位置、流出道阻力以及许多其他因素可能都起作用。
