Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Centre, New York Medical College, NY, USA.
Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Centre, New York, NY, USA.
Eur J Vasc Endovasc Surg. 2022 Jun;63(6):864-873. doi: 10.1016/j.ejvs.2022.04.002. Epub 2022 Apr 8.
Data on the efficacy of non-reversed and reversed great saphenous vein bypass (NRGSV and RGSV) techniques are lacking. The aim of the study was to compare the outcomes of patients undergoing open infrainguinal revascularisation using NRGSV and RGSV from a multi-institutional database.
The Vascular Quality Initiative database was queried for patients undergoing infrainguinal bypasses using NRGSV and RGSV for symptomatic occlusive disease from January 2003 to February 2021. The primary outcome measures included primary and secondary patency at discharge and one year. Secondary outcomes were re-interventions at discharge and one year. Cox proportional hazards models were used to evaluate the impact of graft configuration on outcomes of interest.
Of 7 123 patients, 4 662 and 2 461 patients underwent RGSV and NRGSV, respectively. At one year, the rates of primary patency (78% vs. 78%; p = .83), secondary patency (90% vs. 89%; p = .26), and re-intervention (16% vs. 16%; p = .95) were similar between the RGSV and NRGSV cohorts, respectively. Subgroup analysis based on outflow bypass target and indication for revascularisation did not show differences in primary and secondary outcomes between the two groups. Multivariable analysis confirmed that RGSV (NRGSV as the reference) configuration was not independently associated with increased risk of primary patency loss (hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.91 - 1.13; p = .80), secondary patency loss (HR 0.94; 95% CI 0.81 - 1.10; p = .44), and re-intervention (HR 1.03; 95% CI 0.91 - 1.16; p = .67) at follow up.
The study shows that RGSV and NRGSV grafting techniques have comparable peri-operative and one year primary and secondary patency and re-intervention rates. This effect persisted when stratified by outflow targets and indication for revascularisation. Therefore, optimal selection of vein grafting technique should be guided by the patient's anatomy, vein conduit availability, and surgeon's experience.
缺乏非反转和反转大隐静脉旁路（NRGSV 和 RGSV）技术疗效的数据。本研究的目的是比较多机构数据库中接受 NRGSV 和 RGSV 行开放式下肢动脉血运重建术患者的结局。
从 2003 年 1 月至 2021 年 2 月，对 Vascular Quality Initiative 数据库中因症状性闭塞性疾病行下肢旁路术的患者进行检索，使用 NRGSV 和 RGSV 进行治疗。主要观察指标包括出院时和 1 年时的一期和二期通畅率。次要结局是出院和 1 年时的再干预。Cox 比例风险模型用于评估移植物构型对感兴趣结局的影响。
在 7123 例患者中，分别有 4662 例和 2461 例患者接受了 RGSV 和 NRGSV 治疗。在 1 年时，RGSV 和 NRGSV 组的一期通畅率（78%比 78%；p=0.83）、二期通畅率（90%比 89%；p=0.26）和再干预率（16%比 16%；p=0.95）相似。基于流出道旁路靶血管和血运重建适应证的亚组分析显示，两组间主要和次要结局无差异。多变量分析证实，RGSV（NRGSV 作为参照）构型与一期通畅率丧失的风险增加无关（风险比[HR]1.01；95%置信区间[CI]0.91-1.13；p=0.80）、二期通畅率丧失（HR 0.94；95%CI 0.81-1.10；p=0.44）和再干预（HR 1.03；95%CI 0.91-1.16；p=0.67）。
该研究表明，RGSV 和 NRGSV 移植物技术在围手术期及 1 年时的一期和二期通畅率和再干预率方面具有可比性。当按流出靶血管和血运重建适应证分层时，这种效果仍然存在。因此，静脉移植物技术的最佳选择应根据患者的解剖结构、静脉移植物的可用性和外科医生的经验来指导。
