Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy.
Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy.
J Vasc Surg. 2020 Oct;72(4):1413-1420. doi: 10.1016/j.jvs.2019.11.054. Epub 2020 Feb 5.
To compare the results of polytetrafluoroethylene (PTFE) and great saphenous vein (GSV) bypass after resection of a degenerative aneurysm of the carotid artery.
From January 1994 to November 2017, 37 patients (27 men) with a mean age of 58 years (range, 39-82 years) with a degenerative aneurysm of the carotid artery (median diameter, 28 mm; range, 19-42 mm), underwent resection of the aneurysm followed by a bypass with either a GSV (n = 10) or a PTFE prosthesis (n = 27). Although 31 patients were asymptomatic, 6 patients were symptomatic: transient ischemic attack (n = 4), minor stroke (n = 1), and compression of the hypoglossal nerve (n = 1). The preoperative workup included duplex ultrasound examination of the arteries to the head, and angiography or computed tomography angiography. All patients were operated under general anesthesia and six were intubated through the nose. Sixteen patients were monitored through transcutaneous oximetry. No shunt was used in this series. In 10 patients receiving a PTFE graft, the external carotid artery was implanted in the prosthesis. Mean follow-up was 16.9 ± 2 years (95% confidence interval, 14.5-19.3 years). Primary end points were the 30-day combined stroke/death rate, graft infection, late graft patency, and late stroke-free survival. Secondary end points were cranial nerve injury and length of postoperative hospital stay.
Postoperative mortality was nil in both groups. One postoperative stroke was observed in the PTFE group, whereas none occurred in the GSV group (P = .84). No graft infection was observed in either group. At 10 years, survival in the GSV group was 80 ± 12%, and survival in the PTFE group was 76 ± 8% (log-rank [Mantel-Cox], P = .85). In the GSV group, graft patency at 7 and 10 years was 85 ± 13%. In the PTFE group B, graft patency was 100% (log-rank [Mantel-Cox], P = .12). No late stroke was observed. Two transient cranial nerve injuries were observed in the GSV group (20%) and two in the PTFE group (8%) (P = .97). Length of hospital stay was comparable in both groups (GSV group, 6 days; PTFE group, 5 days; P = .12).
This study suggests that, after resection of a degenerative aneurysm of the carotid artery, bypass with a PTFE prosthesis gives comparable results to those obtained with the GSV. We recommend sparing the GSV and instead using a PTFE prosthesis in patients with a degenerative aneurysm of the carotid artery.
比较聚四氟乙烯（PTFE）和大隐静脉（GSV）旁路在颈动脉退行性动脉瘤切除术后的结果。
从 1994 年 1 月至 2017 年 11 月，37 例（男 27 例）年龄 58 岁（范围，39-82 岁）的退行性颈动脉动脉瘤患者（中位数直径 28mm；范围，19-42mm），接受动脉瘤切除术，随后行旁路手术，其中 10 例行 GSV 旁路（n=10），27 例行 PTFE 假体旁路（n=27）。虽然 31 例患者无症状，但 6 例患者有症状：短暂性脑缺血发作（n=4）、轻度中风（n=1）和舌下神经受压（n=1）。术前检查包括头颈部动脉的双功能超声检查和血管造影或计算机断层血管造影。所有患者均在全身麻醉下接受手术，其中 6 例通过鼻插管。16 例患者通过经皮血氧饱和度监测。本系列未使用分流术。在接受 PTFE 移植物的 10 例患者中，颈外动脉被植入假体。平均随访 16.9±2 年（95%置信区间，14.5-19.3 年）。主要终点为 30 天内联合卒中/死亡率、移植物感染、晚期移植物通畅率和晚期无卒中生存率。次要终点为颅神经损伤和术后住院时间。
两组术后均无死亡。PTFE 组 1 例术后发生卒中，GSV 组无卒中（P=0.84）。两组均无移植物感染。10 年时，GSV 组的存活率为 80±12%，PTFE 组为 76±8%（对数秩[Mantel-Cox]，P=0.85）。GSV 组在 7 年和 10 年时的移植物通畅率分别为 85±13%。PTFE 组 B 的移植物通畅率为 100%（对数秩[Mantel-Cox]，P=0.12）。无晚期卒中发生。GSV 组有 2 例（20%）和 PTFE 组有 2 例（8%）短暂性颅神经损伤（P=0.97）。两组的住院时间相似（GSV 组 6 天；PTFE 组 5 天；P=0.12）。
本研究表明，在切除颈动脉退行性动脉瘤后，PTFE 假体旁路与 GSV 旁路的结果相当。我们建议保留 GSV，并在颈动脉退行性动脉瘤患者中使用 PTFE 假体。
