Schwarz W, Nozick J, Richmand D, Rodgers B, Simpson A, Argila C, Honickman S
AJR Am J Roentgenol. 1986 Mar;146(3):605-8. doi: 10.2214/ajr.146.3.605.
The use of the in situ saphenous vein for bypassing arterial occlusions in the lower extremities appears to have a higher patency rate than other bypass procedures but presents unique technical problems, such as lysing valves and occluding venous tributaries. Forty-four patients undergoing in situ bypasses had preoperative arteriograms. Special attention was paid to the small runoff vessels around the ankle, which are not suitable for reversed bypass procedures but may be adequate for in situ bypasses. Eight patients also had preoperative saphenous venograms, which revealed surgically important abnormalities in six cases. Postoperative arteriograms obtained within 2 weeks in 10 patients and within 2-12 months in 15 patients revealed persistent arteriovenous fistulas in four patients, stenoses in nine, occlusions in five, and progressive disease in the nonbypassed arteries in five patients. Early recognition of these problems led to 11 surgical repairs; nine repairs used the interventional radiologic procedures of balloon angioplasty, transcatheter embolization, and catheter thrombolysis. In this group of 44 patients, five patients died with patent bypasses and three patients required amputation despite functioning bypasses. Only four amputations were attributed to bypass failure. This low figure may be due to the close cooperation of the vascular surgeons and the vascular radiologists in dealing with these complicated cases.
使用原位大隐静脉绕过下肢动脉闭塞处，其通畅率似乎高于其他旁路手术，但存在独特的技术问题，如瓣膜溶解和静脉属支闭塞。44例行原位旁路手术的患者术前行动脉造影。特别关注踝关节周围的小分支血管，这些血管不适合行逆行旁路手术，但可能适合原位旁路手术。8例患者术前行大隐静脉造影，其中6例显示出具有手术重要性的异常。10例患者在术后2周内、15例患者在术后2至12个月行动脉造影，结果显示4例患者存在持续性动静脉瘘，9例有狭窄，5例有闭塞，5例患者未行旁路手术的动脉出现进行性病变。对这些问题的早期识别导致了11次手术修复；9次修复采用了球囊血管成形术、经导管栓塞术和导管溶栓术等介入放射学方法。在这组44例患者中，5例患者在旁路通畅的情况下死亡，3例患者尽管旁路功能正常仍需截肢。只有4例截肢归因于旁路失败。这一低数字可能归因于血管外科医生和血管放射科医生在处理这些复杂病例时的密切合作。
