Ameli F M, Provan J L, Williamson C, Keuchler P M
Division of Vascular Surgery, Wellesley Hospital, University of Toronto, Canada.
J Cardiovasc Surg (Torino). 1987 Nov-Dec;28(6):695-700.
Over a nine-year period 1973 to 1982, 364 aorto-bifemoral bypass grafts were inserted for aorto-iliac occlusive disease and 45 graft failures were encountered. Twelve patients developed acute graft occlusion, occurring less than 30 days postoperatively (Group I). These failures were almost all due to technical problems, the most common cause was elevation of an intimal flap following local endarterectomy. Five patients (Group II) developed recurrent symptoms without actual thrombosis or occlusion of the graft, but were associated with neointimal hyperplasia at the distal anastomosis and evidence of distal atherosclerosis. Twenty-eight patients were late failures (Group III). These patients thrombosed their grafts more than 30 days postoperatively. Four patients thrombosed both limbs of the graft at separate intervals. Nineteen patients were found to have progressive atherosclerosis affecting their run-off vessels. Six patients were found to have stenosis limited to the distal anastomosis. False aneurysm, kinking of the graft, and proximal suture line stenosis were felt to be determining factors in 3 other incidences of graft failure. The most common treatment in Group I was thrombectomy and securing of the raised intimal flap. The patients in Group II were treated with local endarterectomy and patch angioplasty. Of the patients in Group III, the most common inflow procedure was thrombectomy, carried out in 17 cases. In Group III, 13 of 28 patients underwent profundaplasty to improve outflow. The importance of pre and postoperative angiography in defining the etiology of graft failure is stressed. It is important to rule out problems with the proximal anastomosis. Once inflow has been established, angiography should ensure that an adequate outflow procedure has been performed.(ABSTRACT TRUNCATED AT 250 WORDS)
在1973年至1982年的九年期间，因主-髂动脉闭塞性疾病进行了364例主-双股动脉搭桥移植术，其中45例出现移植失败。12例患者发生急性移植血管闭塞，发生在术后不到30天（第一组）。这些失败几乎都归因于技术问题，最常见的原因是局部内膜剥脱术后内膜瓣的抬起。5例患者（第二组）出现复发症状，但移植血管无实际血栓形成或闭塞，与远端吻合口处的新生内膜增生及远端动脉粥样硬化证据有关。28例患者为晚期失败（第三组）。这些患者在术后30天以上移植血管发生血栓形成。4例患者移植血管的双下肢在不同时间发生血栓形成。19例患者被发现有影响其流出道血管的进行性动脉粥样硬化。6例患者被发现狭窄仅限于远端吻合口。假性动脉瘤、移植血管扭结和近端缝合线狭窄被认为是另外3例移植失败的决定因素。第一组最常见的治疗方法是血栓切除术和固定抬起的内膜瓣。第二组患者接受局部内膜剥脱术和补片血管成形术治疗。在第三组患者中，最常见的流入道手术是血栓切除术，17例患者接受了该手术。在第三组中，28例患者中有13例接受了股深动脉成形术以改善流出道。强调了术前和术后血管造影在确定移植失败病因方面的重要性。排除近端吻合口问题很重要。一旦确定了流入道，血管造影应确保已进行了充分的流出道手术。（摘要截短至250字）
