Harris R W, Andros G, Salles-Cunha S X, Dulawa L B, Oblath R W, Apyan R
Surgery. 1986 Nov;100(5):822-7.
Autogenous veins other than single-length greater saphenous vein were used in 150 operations to revascularize the extremities of 138 patients; three operations were for upper extremity ischemia and four were lower extremity reconstructions with lesser saphenous vein grafts. The remaining 143 bypasses were performed to revascularize lower extremities in 131 patients. Arm vein grafts were used in 102 operations, and 14 different combinations of vein segments were used to construct 41 totally autogenous composite vein grafts. Tissue necrosis or rest pain was the indication for 70% of arm vein bypasses; 52% of these grafts extended to an infrapopliteal artery. The 1-, 3-, and 5-year patency rates were 82%, 69%, and 60%, resulting in limb salvage rates of 93%, 91%, and 81%, respectively. Composite autogenous vein grafts resulted in a 1-year limb salvage rate of 79% in a select group of elderly patients with advanced arterial disease, poor runoff, and profound ischemia. Limb salvage was the indication for 93% of these operations; tissue necrosis was present in 71% while 80% required infrapopliteal reconstructions--37% to a peroneal artery and 29% to the ankle or foot. Successful limb salvage has been accomplished with alternative autogenous veins when the greater saphenous vein is missing or inadequate, dramatically reducing the use of prosthetic conduits in our practice.
在150例手术中，使用了除单段大隐静脉以外的自体静脉，为138例患者的肢体进行血管重建；3例手术用于上肢缺血，4例下肢重建使用小隐静脉移植物。其余143例旁路手术为131例患者的下肢进行血管重建。102例手术使用了手臂静脉移植物，14种不同的静脉段组合用于构建41个完全自体复合静脉移植物。组织坏死或静息痛是70%的手臂静脉旁路手术的指征；其中52%的移植物延伸至腘下动脉。1年、3年和5年通畅率分别为82%、69%和60%，肢体挽救率分别为93%、91%和81%。在一组患有晚期动脉疾病、流出道差和严重缺血的老年患者中，复合自体静脉移植物的1年肢体挽救率为79%。肢体挽救是这些手术中93%的指征；71%存在组织坏死，80%需要腘下重建——37%至腓动脉，29%至踝部或足部。当大隐静脉缺失或不足时，使用替代自体静脉已成功实现肢体挽救，在我们的实践中显著减少了人工血管的使用。
