Kikta M J, Flanigan D P, Bishara R A, Goodson S F, Schuler J J, Meyer J P
J Vasc Surg. 1987 Feb;5(2):319-28.
Because infrainguinal bypasses performed on the basis of normal papaverine testing in patients with multilevel arterial occlusive disease are done below arteriographically diseased although hemodynamically normal vessels, there is concern about progression of suprainguinal disease compromising long-term success. This study has been done to assess the long-term results of such bypasses. Between 1979 and 1985, infrainguinal bypasses selected by papaverine testing were done on 92 limbs having hemodynamically normal inflow in the presence of arteriographically demonstrable aortoiliac stenoses of 15% to 70%. Long-term hemodynamic and clinical success rates were determined with criteria based on papaverine and noninvasive vascular testing. There was no significant difference in hemodynamic success at 48 months (by life-table analysis) (p = 0.98) when comparing limbs with less than 50% aortoiliac stenoses to limbs having 50% or greater stenoses. The difference between the mean degree of preoperative inflow stenoses for long-term hemodynamic successes (32.5% +/- 1.5%) and failures (34.6% +/- 3.0%) was not significant (p = 0.57). There was no significant difference (p = 0.98) in the number of subsequent inflow procedures required in limbs with preoperative aortoiliac stenoses of less than 50% (13.5%) vs. aortoiliac stenoses of 50% or greater (13.3%). Long-term results of infrainguinal bypass done below stenotic but hemodynamically normal aortoiliac vessels are not related to the amount of angiographically demonstrable inflow stenosis. Selection of patients for infrainguinal bypass on the basis of papaverine testing, irrespective of angiographic findings, eliminates unnecessary inflow procedures without detriment to long-term success.
由于在患有多节段动脉闭塞性疾病的患者中，基于罂粟碱试验正常而进行的股腘以下旁路手术是在血管造影显示病变但血流动力学正常的血管下方进行的，因此人们担心腹股沟以上疾病的进展会影响长期手术成功率。本研究旨在评估此类旁路手术的长期效果。1979年至1985年期间，对92条肢体进行了基于罂粟碱试验选择的股腘以下旁路手术，这些肢体在血管造影显示腹主动脉髂动脉狭窄15%至70%的情况下血流动力学正常。根据罂粟碱和无创血管检测标准确定长期血流动力学和临床成功率。比较腹主动脉髂动脉狭窄小于50%的肢体与狭窄50%或更高的肢体，48个月时的血流动力学成功率（通过寿命表分析）无显著差异（p = 0.98）。长期血流动力学成功组（32.5% +/- 1.5%）和失败组（34.6% +/- 3.0%）术前流入道狭窄平均程度的差异不显著（p = 0.57）。术前腹主动脉髂动脉狭窄小于50%的肢体（13.5%）与狭窄50%或更高的肢体（13.3%）所需后续流入道手术数量无显著差异（p = 0.98）。在狭窄但血流动力学正常的腹主动脉髂动脉血管下方进行的股腘以下旁路手术的长期效果与血管造影显示的流入道狭窄程度无关。基于罂粟碱试验选择患者进行股腘以下旁路手术，无论血管造影结果如何，都可以避免不必要的流入道手术，且不影响长期成功率。
