Department of Surgery, Massachusetts General Hospital, Boston, MA.
Department of Surgery, Massachusetts General Hospital, Boston, MA.
Ann Vasc Surg. 2023 Jul;93:137-141. doi: 10.1016/j.avsg.2023.02.036. Epub 2023 Mar 9.
Recent studies have demonstrated increased postoperative patency with the use of routine completion angiography for bypass using venous conduit. Compared to vein conduits, however, prosthetic conduits are less plagued by technical issues such as unlysed valves or arteriovenous fistulae. The effect of routine completion angiography on bypass patency in prosthetic bypasses has yet to be compared to the more traditional selective use of completion imaging.
A retrospective review of all infrainguinal bypass procedures using prosthetic conduit completed at a single hospital system from 2001 to 2018 was performed. Demographics, comorbidities, intraoperative reintervention rates, and 30-day rates of graft thrombosis were analyzed. Statistical analysis included t-tests, chi-square tests, and cox regression.
Four hundred and ninety-eight bypasses that were performed in 426 patients met inclusion criteria. Fifty-six (11.2%) bypasses were classified into the routine completion angiogram group compared to 442 (88.8%) into the no completion angiogram group. Patients who underwent routine completion angiograms had a rate of intraoperative reintervention of 21.4%. When comparing bypasses that underwent routine completion angiography versus no completion angiography, there were no significant differences in rates of reintervention (3.5% vs. 4.5%, P = 0.74) or graft occlusion (3.5% vs. 4.7%, P = 0.69) at 30-days postoperatively.
Almost one-quarter of lower extremity bypasses using prosthetic conduit that undergo routine completion angiography undergo postangiogram bypass revision; however, this is not associated with an increased graft patency at 30 days postoperatively.
最近的研究表明，在使用静脉移植物进行旁路手术时，常规进行完成血管造影可提高术后通畅率。然而，与静脉移植物相比，人工移植物较少受到未溶解的瓣膜或动静脉瘘等技术问题的困扰。常规完成血管造影对人工旁路通畅率的影响尚未与更传统的选择性完成成像进行比较。
对 2001 年至 2018 年期间在单一医院系统完成的所有使用人工移植物的下肢旁路手术进行回顾性审查。分析了人口统计学资料、合并症、术中再次干预率以及 30 天内移植物血栓形成率。统计分析包括 t 检验、卡方检验和 Cox 回归。
符合纳入标准的 426 例患者中有 498 例旁路手术。56 例（11.2%）旁路手术分为常规完成血管造影组，442 例（88.8%）分为无完成血管造影组。接受常规完成血管造影的患者术中再次干预率为 21.4%。比较行常规完成血管造影与不行完成血管造影的旁路手术，再干预率（3.5%比 4.5%，P=0.74）或术后 30 天移植物闭塞率（3.5%比 4.7%，P=0.69）无显著差异。
近四分之一接受常规完成血管造影的下肢旁路手术中使用人工移植物，术后行血管造影旁路修正术；然而，这并不与术后 30 天移植物通畅率增加相关。
