Fogle M A, Whittemore A D, Couch N P, Mannick J A
J Vasc Surg. 1987 Jan;5(1):46-52.
Despite the recent popularity of the in situ saphenous vein graft for infrainguinal arterial reconstruction, considerable doubt exists as to whether this approach offers any real advantage over conventional reversed vein grafts. Therefore we have reviewed our experience with 675 infrainguinal vein grafts undertaken during the past 10 years. There have been no substantial modifications in the technique used for 535 reversed vein grafts over the 10-year period. During the past 3 years, 140 in situ vein grafts have been carried out with the Leather valvulotome used to incise the venous valves. Life-table analysis of 449 femoropopliteal reversed saphenous vein grafts demonstrated 1- and 3-year cumulative patency rates of 81% and 73%, respectively, and a 5-year patency rate of 63%. Seventy-five femoropopliteal in situ bypasses demonstrated a patency rate of 85% at both 1- and 3-year intervals. Cumulative patency rates for 86 femoroinfrapopliteal reversed saphenous vein grafts were 64% and 62% at 1 and 3 years, respectively. Comparable patency rates for 65 infrapopliteal in situ saphenous vein grafts remained stable at 87% for 3 years. Fifteen of the in situ bypasses were anastomosed to vessels at the ankle or foot level, whereas none of the reversed bypasses was carried that far distally. This experience with both in situ and reversed techniques on one service by the same surgeons demonstrates a clear superiority of the in situ saphenous vein graft for infrapopliteal reconstruction at the 3-year interval.
尽管近期原位大隐静脉移植用于下肢动脉重建颇受青睐，但对于该方法是否比传统的倒置静脉移植具有任何实际优势仍存在相当大的疑问。因此，我们回顾了过去10年中进行的675例下肢静脉移植的经验。在这10年期间，535例倒置静脉移植所采用的技术并无实质性改变。在过去3年中，使用皮革瓣膜刀切开静脉瓣膜进行了140例原位静脉移植。对449例股腘倒置大隐静脉移植进行的生存分析表明，1年和3年的累积通畅率分别为81%和73%，5年通畅率为63%。75例股腘原位旁路移植在1年和3年时的通畅率均为85%。86例股腘下倒置大隐静脉移植的1年和3年累积通畅率分别为64%和62%。65例腘下原位大隐静脉移植的类似通畅率在3年内保持稳定，为87%。15例原位旁路移植吻合至踝关节或足部水平的血管，而倒置旁路移植均未到达如此远的远端。同一外科团队在同一科室对原位和倒置技术的这种经验表明，在3年时，原位大隐静脉移植用于腘下重建具有明显优势。
