自体与同种异体大隐静脉在脑血运重建手术中的比较疗效。
Comparative efficacy of autologous versus cadaveric saphenous vein grafts in cerebral revascularization surgery.
出版信息
J Neurosurg. 2020 May 22;134(5):1562-1568. doi: 10.3171/2020.3.JNS192546. Print 2021 May 1.
OBJECTIVE
Cerebral bypasses are performed for the purpose of either flow augmentation for ischemic cerebrovascular disease or flow replacement for vessel sacrifice during complex aneurysm or tumor surgery. Saphenous vein grafts (SVGs) are commonly used interposition grafts. The authors of this study sought to compare the efficacy of autologous versus cadaveric SVGs in a large series of cerebral bypasses using interposition vein grafts with long-term angiographic follow-up.
METHODS
All intracranial bypass procedures performed between 2001 and 2018 were reviewed. Demographic, clinical, angiographic, and operative data were recorded and then analyzed according to SVG type.
RESULTS
A total of 308 consecutive intracranial bypasses were performed during the study period, 53 (17.2%) of which were bypasses with an interposition SVG (38 autologous, 15 cadaveric). At a median follow-up of 2.2 months (IQR 0.2-29.1), 39 (73.6%) bypasses were patent (26 [68.4%] autologous, 13 [86.7%] cadaveric, p = 0.30). Comparing autologous and cadaveric SVG recipients, there were no statistically significant differences in age (p = 0.50), sex (p > 0.99), history of smoking (p = 0.75), hypertension (p > 0.99), diabetes mellitus (p = 0.13), indication for bypass (p = 0.27), or SVG diameter (p = 0.65). While there were higher intraoperative (autologous, 100.0 ml/min, IQR 84.3-147.5; cadaveric, 80.0 ml/min, IQR 47.3-107.8; p = 0.11) and postoperative (autologous, 142.2 ml/min, IQR 76.8-160.8; cadaveric, 92.0 ml/min, IQR 69.2-132.2; p = 0.42) volumetric flow rates in the autologous SVGs compared to those in the cadaveric SVGs, the difference between the two groups did not reach statistical significance. In addition, the blood flow index, or ratio of postoperative to intraoperative blood flow, for each bypass was similar between the groups (autologous, 1.3, IQR 0.9-1.6; cadaveric, 1.5, IQR 1.0-2.3; p = 0.37). Kaplan-Meier estimates showed no difference in bypass patency rates over time between autologous and cadaveric SVGs (p = 0.58).
CONCLUSIONS
Cadaveric SVGs are a reasonable interposition graft option in cerebral revascularization surgery when autologous grafts are not available.
目的
脑旁路手术的目的是为缺血性脑血管病增加血流，或在复杂的动脉瘤或肿瘤手术中为血管牺牲提供血流替代。大隐静脉移植物（SVGs）通常用作中间移植移植物。本研究的作者旨在使用带长期血管造影随访的中间静脉移植物比较自体与尸体 SVG 在大量脑旁路中的疗效。
方法
回顾了 2001 年至 2018 年期间进行的所有颅内旁路手术。记录了人口统计学、临床、血管造影和手术数据，并根据 SVG 类型进行了分析。
结果
在研究期间共进行了 308 例连续颅内旁路手术，其中 53 例（17.2%）为带中间 SVG 的旁路手术（38 例自体，15 例尸体）。在中位随访 2.2 个月（IQR 0.2-29.1）时，39 例旁路通畅（26 例[68.4%]自体，13 例[86.7%]尸体，p=0.30）。比较自体和尸体 SVG 受者，在年龄（p=0.50）、性别（p＞0.99）、吸烟史（p=0.75）、高血压（p＞0.99）、糖尿病（p=0.13）、旁路指征（p=0.27）或 SVG 直径（p=0.65）方面无统计学显著差异。虽然自体 SVG 的术中（自体，100.0ml/min，IQR 84.3-147.5；尸体，80.0ml/min，IQR 47.3-107.8；p=0.11）和术后（自体，142.2ml/min，IQR 76.8-160.8；尸体，92.0ml/min，IQR 69.2-132.2；p=0.42）容积血流率较高，但两组间差异无统计学意义。此外，两组间每个旁路的血流指数（即术后与术中血流比）相似（自体，1.3，IQR 0.9-1.6；尸体，1.5，IQR 1.0-2.3；p=0.37）。Kaplan-Meier 估计显示自体和尸体 SVG 旁路通畅率随时间无差异（p=0.58）。
结论
当自体移植物不可用时，尸体 SVG 是脑血运重建手术中一种合理的中间移植移植物选择。
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