Green R M, Ouriel K, Ricotta J J, DeWeese J A
Surgery. 1986 Oct;100(4):646-54.
Our experience with 112 patients whose infrainguinal bypass grafts (IIBPGs) failed more than 30 days after insertion was reviewed. Cumulative patency rates (CPRs) after graft revision (GR) were 71% at 6 months, 62% at 12 months, 57% at 24 months, 54% at 36 months, and 46% at 48 months. CPRs of IIBPGs that failed more than 12 months after insertion were higher than those of grafts that failed earlier (60% vs. 36% at 36 months (p less than 0.05). Failure of the initial GR did not preclude a successful secondary revision. The 3-year CPR of the initial GR was 31% compared with 49% for secondary GR (p = no significance). The results of GR are significantly better when graft failure is diagnosed before graft thrombosis. Revision of the 37 hemodynamically failed but patent grafts resulted in a CPR of 89% at 12 months and 77% at 36 months compared with a CPR of 33% at 12 months and 26% at 36 months after revision of the 75 thrombosed grafts (p less than 0.01). Hemodynamically failed but patent grafts occurred in 36 of 68 patients (53%) with failed autogenous veins but only 1 of 44 patients (2%) with a failed prosthetic graft had GR before thrombosis of the graft. There is a significant improvement in early CPR when a new bypass graft is inserted as compared with original graft thrombectomy and angioplasty. The CPR for new bypass grafts at 6 and 12 months was 61% and 41%, respectively, compared with a CPR of 26% and 20% for the same time intervals with graft thrombectomy and angioplasty (p less than 0.05). The presence of thrombus in the outflow artery at the site of GR is a contraindication to anastomosis at that site even if arterial thrombectomy reestablishes backflow. When distal arterial thrombus was not present, the CPR after GR was 62% at 6 months, 42% at 12 months, and 33% at 36 months. When distal arterial thrombectomy was necessary, the CPR after GR was only 14% at 6 months and zero at 12 months (p less than 0.05).
我们回顾了112例患者的情况，这些患者的腹股沟下旁路移植术（IIBPG）在植入后30天以上失败。移植修复（GR）后的累积通畅率（CPR）在6个月时为71%，12个月时为62%，24个月时为57%，36个月时为54%，48个月时为46%。植入后超过12个月失败的IIBPG的CPR高于早期失败的移植（36个月时分别为60%和36%，p小于0.05）。初次GR失败并不排除二次修复成功。初次GR的3年CPR为31%，而二次GR为49%（p无显著性差异）。当在移植血栓形成之前诊断出移植失败时，GR的结果明显更好。对37例血流动力学失败但通畅的移植进行修复后，12个月时CPR为89%，36个月时为77%，而75例血栓形成的移植修复后12个月时CPR为33%，36个月时为26%（p小于0.01）。68例自体静脉失败患者中有36例（53%）出现血流动力学失败但通畅的移植，而44例人工血管失败患者中只有1例（2%）在移植血栓形成前进行了GR。与最初的移植血栓切除术和血管成形术相比，插入新的旁路移植时早期CPR有显著改善。新旁路移植在6个月和12个月时的CPR分别为61%和41%，而移植血栓切除术和血管成形术在相同时间间隔的CPR分别为26%和20%（p小于0.05）。GR部位的流出动脉中存在血栓是该部位吻合的禁忌症，即使动脉血栓切除术恢复了血流。当不存在远端动脉血栓时，GR后的CPR在6个月时为62%，12个月时为42%，36个月时为33%。当需要进行远端动脉血栓切除术时，GR后的CPR在6个月时仅为14%，12个月时为零（p小于0.05）。
