Strayhorn E C, Wohlgemuth S, Deuel M, Glickman M H, Hurwitz R L
Eastern Virginia Medical School, Vascular and Transplant Surgery.
J Cardiovasc Surg (Torino). 1988 Mar-Apr;29(2):161-5.
We have compared our early and late experience utilizing in situ saphenous vein bypass graft for lower extremity arterial occlusive disease in 54 patients who underwent in situ femoral to popliteal and distal bypass grafts between July of 1983 and February 1985. There were 3 femoral to above-knee popliteal bypasses, 27 femoral to below-knee popliteal bypass grafts, 12 femoral to anterior tibial dorsalis pedis bypass grafts, 10 femoral to posterior tibial bypass grafts and 2 femoral to peroneal in situ bypass grafts. The operative indications were progressive disabling claudication in 8 (15%) and limb salvage in 46 (85%). Eighty-nine percent of the limb salvage patients had 0-1 vessel runoff by arteriogram. Cumulative life table patency of the 54 in situ bypass grafts was 79% at 20 months. One hundred percent of the patients who were operated on for disabling claudication had patent grafts at 20 months. Seventy-eight percent of the limb salvage patients had patent grafts. Fourteen of the limb salvage patients required amputation and of these 14, 10 had patent grafts at the time of amputation. There were 8 deaths in the series. Our results demonstrate that a definite learning curve exists with this technique, however, once established, long-term patency and improved limb salvage statistics can be obtained.
我们比较了1983年7月至1985年2月期间54例行原位股动脉至腘动脉及远端旁路移植术治疗下肢动脉闭塞性疾病的患者早期和晚期的经验。其中有3例股动脉至膝上腘动脉旁路移植术、27例股动脉至膝下腘动脉旁路移植术、12例股动脉至胫前动脉及足背动脉旁路移植术、10例股动脉至胫后动脉旁路移植术以及2例股动脉至腓动脉原位旁路移植术。手术适应证为8例（15%）进行性致残性间歇性跛行和46例（85%）肢体挽救。89%的肢体挽救患者动脉造影显示有0 - 1级血管流出道。54例原位旁路移植术的累积生存表通畅率在20个月时为79%。因致残性间歇性跛行接受手术的患者在20个月时移植血管均通畅。78%的肢体挽救患者移植血管通畅。14例肢体挽救患者需要截肢，其中10例在截肢时移植血管通畅。该系列中有8例死亡。我们的结果表明，这项技术存在明确的学习曲线，然而，一旦掌握，就可以获得长期通畅率和改善的肢体挽救统计数据。
