Taylor L M, Phinney E S, Porter J M
J Vasc Surg. 1986 Feb;3(2):288-97.
During the past 4 years we have performed 239 reversed vein bypasses for leg ischemia in 196 patients including 45 to the above-knee popliteal artery, 118 to the below-knee popliteal artery, and 76 to infrapopliteal arteries. The cumulative primary patency results by the life-table method through 24 months are 97% at 6 months, 91% at 1 year, and 88% at 2 years. No difference was evident in patency rates with respect to site of distal anastomosis or reason for graft performance (i.e., for claudication [31%] or for limb salvage [69%]). Twenty-two percent of these patients did not have an intact ipsilateral greater saphenous vein. By a variety of techniques including the use of cephalic and lesser saphenous veins, vein splicing, and proximal superficial femoral endarterectomy, we have been able to perform autogenous vein bypass in 94% of all patients who require lower extremity revascularization. The patency of bypasses made from conduits other than greater saphenous vein does not differ from that of the entire series. Both the graft patency and vein utilization rates in the present report are equal to those of recently published series of in situ saphenous vein bypasses and are clearly better than the published results with reversed vein bypass a decade and more ago. We conclude that, although in situ saphenous vein bypass is a good procedure, it is not superior to reversed vein bypass performed in the same time period. This report again emphasizes the hazards of evaluating any new treatment by use of historic controls.
在过去4年中，我们对196例腿部缺血患者进行了239例静脉转流术，其中45例吻合至腘动脉上段，118例吻合至腘动脉下段，76例吻合至腘动脉以下动脉。采用寿命表法得出的24个月累计原发性通畅率结果为：6个月时97%，1年时91%，2年时88%。远端吻合部位或移植血管使用原因（即用于间歇性跛行[31%]或肢体挽救[69%]）对通畅率无明显影响。这些患者中有22%同侧大隐静脉不完整。通过包括使用头静脉和小隐静脉、静脉拼接以及股浅动脉近端内膜切除术等多种技术，我们能够在所有需要下肢血管重建的患者中94%进行自体静脉转流术。使用非大隐静脉的血管进行转流术的通畅率与整个系列的通畅率无差异。本报告中的移植血管通畅率和静脉利用率与近期发表的原位大隐静脉转流术系列报告相当，且明显优于十多年前发表的静脉转流术结果。我们得出结论，尽管原位大隐静脉转流术是一种良好的术式，但并不优于同期进行的静脉转流术。本报告再次强调了使用历史对照评估任何新治疗方法的风险。
