Veith F J, Gupta S K, Ascer E, White-Flores S, Samson R H, Scher L A, Towne J B, Bernhard V M, Bonier P, Flinn W R
J Vasc Surg. 1986 Jan;3(1):104-14. doi: 10.1067/mva.1986.avs0030104.
Autologous saphenous vein (ASV) and polytetrafluoroethylene (PTFE) grafts were compared in 845 infrainguinal bypass operations, 485 to the popliteal artery and 360 to infrapopliteal arteries. Life-table primary patency rates for randomized PTFE grafts to the popliteal artery paralleled those for randomized ASV grafts to the same level for 2 years and then became significantly different (4-year patency rate of 68% +/- 8% [SE] for ASV vs. 47% +/- 9% for PTFE, p less than 0.025). Four-year patency differences for randomized above-knee grafts were not statistically significant (61% +/- 12% for ASV vs. 38% +/- 13% for PTFE, p greater than 0.25) but were for randomized below-knee grafts (76% +/- 9% for ASV vs. 54% +/- 11% for PTFE, p less than 0.05). Four-year limb salvage rates after bypasses to the popliteal artery to control critical ischemia did not differ for the two types of randomized grafts (75% +/- 10% for ASV vs. 70% +/- 10% for PTFE, p greater than 0.25). Although primary patency rates for randomized and obligatory PTFE grafts to the popliteal artery were significantly different (p less than 0.025), 4-year limb salvage rates were not (70% +/- 10% vs. 68% +/- 20%, p greater than 0.25). Primary patency rates at 4 years for infrapopliteal bypasses with randomized ASV were significantly better than those with randomized PTFE (49% +/- 10% vs. 12% +/- 7%, p less than 0.001). Limb salvage rates at 3 1/2 years for infrapopliteal bypasses with both randomized grafts (57% +/- 10% for ASV and 61% +/- 10% for PTFE) were better than those for obligatory infrapopliteal PTFE grafts (38% +/- 11%, p less than 0.01). These results fail to support the routine preferential use of PTFE grafts for either femoropopliteal or more distal bypasses. However, this graft may be used preferentially in selected poor-risk patients for femoropopliteal bypasses, particularly those that do not cross the knee. Although every effort should be made to use ASV for infrapopliteal bypasses, a PTFE distal bypass is a better option than a primary major amputation.
在845例腹股沟下旁路手术中，对自体大隐静脉（ASV）移植物和聚四氟乙烯（PTFE）移植物进行了比较，其中485例为腘动脉旁路手术，360例为腘以下动脉旁路手术。随机分配的PTFE移植物至腘动脉的生命表初始通畅率在2年内与随机分配的ASV移植物至同一水平的通畅率相似，之后出现显著差异（ASV的4年通畅率为68%±8%[标准误]，PTFE为47%±9%，p<0.025）。随机分配的膝上移植物的4年通畅率差异无统计学意义（ASV为61%±12%，PTFE为38%±13%，p>0.25），但膝下移植物的差异有统计学意义（ASV为76%±9%，PTFE为54%±11%，p<0.05）。两种随机分配的移植物用于腘动脉旁路手术以控制严重缺血后的4年肢体挽救率无差异（ASV为75%±10%，PTFE为70%±10%，p>0.25）。虽然随机分配和非随机分配的PTFE移植物至腘动脉的初始通畅率有显著差异（p<0.025），但4年肢体挽救率无差异（70%±10%对68%±20%，p>0.25）。随机分配ASV的腘以下旁路手术4年的初始通畅率显著优于随机分配PTFE的手术（49%±10%对12%±7%，p<0.001）。两种随机分配的移植物进行腘以下旁路手术后3.5年的肢体挽救率（ASV为57%±10%，PTFE为61%±10%）均优于非随机分配的腘以下PTFE移植物（38%±11%，p<0.01）。这些结果不支持常规优先使用PTFE移植物进行股腘或更远端的旁路手术。然而，对于股腘旁路手术，这种移植物可优先用于选定的高危患者，特别是那些不跨越膝关节的患者。尽管应尽一切努力使用ASV进行腘以下旁路手术，但PTFE远端旁路手术比初次大截肢是更好的选择。
Zotero 插件