2nd Department of Surgery, Centre for Vascular Disease, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic.
2nd Department of Surgery, Centre for Vascular Disease, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic.
Ann Vasc Surg. 2024 Jun;103:133-140. doi: 10.1016/j.avsg.2023.12.067. Epub 2024 Feb 28.
Alternative autologous veins can be used as a conduit when adequate great saphenous vein is unavailable. We analyzed the results of our infrainguinal bypasses after adopting upper extremity veins in our practice.
This is a single-center observational study involving all patients whose infrainguinal bypass involved the use of upper extremity veins between April 2019, when we began using arm veins, and February 2023.
During the study period, 49 bypasses were done in 48 patients; mean age 68.1 ± 9.8; men 32 (66.7%); body mass index 28.0 ± 4.8; indications for surgery: chronic limb threatening ischemia 41 (83.7%); acute limb ischemia 3 (6.1%); complications of previous prosthetic 3 (6.1%), or autologous 2 (4.1%) bypass grafts. Vein splicing was used in 43 (87.8%) bypasses with 3-segment grafts being the most common (26; 53.1%). There were 24 (49.0%) femorotibial, 11 (22.4%) femoropopliteal, 9 (18.4%) femoropedal, and 5 (10.2%) extension jump bypass procedures. Eighteen (36.7%) operations were redo surgeries. Twenty-one (42.9%) bypasses were formed using only arm veins. The median follow-up was 12.9 months (4.5-24.2). Two bypasses occluded during the first 30 postoperative days (2/49; 4.1%). Overall 30-day, 1-year, and 2-year primary patency rates were 93.7% ± 3.5%, 84.8% ± 5.9%, and 80.6% ± 6.9%, and secondary patency (SP) rates were 95.8% ± 2.9%, 89.2% ± 5.3%, and 89.2% ± 5.3%. One-segment grafts had better patencies than 2-, 3-, and 4-segment grafts (1-year SP 100% ± 0% vs 87.6% ± 6.0%). Two-year amputation-free survival was 86.8% ± 6.5%; 2-year overall survival was 88.2% ± 6.6%.
Integration of arm vein grafts in infrainguinal bypass practice can be done safely with low incidences of perioperative graft failure. One-segment grafts had better patencies than spliced vein grafts. The achieved early patency and amputation-free survival rates strongly encourage their use. In the absence of a single-segment great saphenous vein, upper extremity vein grafts should be the preferred conduit choice.
当大隐静脉不可用时，可以使用其他自体静脉作为移植物。我们分析了在实践中采用上肢静脉后下肢旁路的结果。
这是一项单中心观察性研究，涉及所有下肢旁路手术中使用上肢静脉的患者，研究时间为 2019 年 4 月（我们开始使用手臂静脉时）至 2023 年 2 月。
研究期间，48 例患者中有 49 例进行了旁路手术；平均年龄 68.1±9.8 岁；男性 32 例（66.7%）；体重指数 28.0±4.8；手术适应证：慢性肢体缺血性威胁 41 例（83.7%）；急性肢体缺血 3 例（6.1%）；先前假体 3 例（6.1%）或自体旁路移植物的并发症 2 例（4.1%）。43 例（87.8%）旁路手术采用静脉拼接，3 段移植物最常见（26 例，53.1%）。有 24 例（49.0%）股腘旁路，11 例（22.4%）股浅旁路，9 例（18.4%）股胫旁路和 5 例（10.2%）延长跳跃旁路手术。18 例（36.7%）为再次手术。仅使用上肢静脉形成了 21 例（42.9%）旁路。中位随访时间为 12.9 个月（4.5-24.2）。术后 30 天内有 2 例（2/49；4.1%）旁路闭塞。总的 30 天、1 年和 2 年的一期通畅率分别为 93.7%±3.5%、84.8%±5.9%和 80.6%±6.9%，二期通畅率分别为 95.8%±2.9%、89.2%±5.3%和 89.2%±5.3%。一段移植物的通畅率优于 2 段、3 段和 4 段移植物（1 年 SP 100%±0%比 87.6%±6.0%）。2 年无截肢生存率为 86.8%±6.5%；2 年总生存率为 88.2%±6.6%。
在下肢旁路手术中加入上肢静脉移植物是安全的，围手术期移植物失败的发生率较低。一段移植物的通畅率优于拼接静脉移植物。早期获得的通畅率和无截肢生存率强烈鼓励使用它们。在没有单段大隐静脉的情况下，上肢静脉移植物应作为首选的导管选择。
