Snyder S O, Wheeler J R, Gregory R T, Gayle R G
J Cardiovasc Surg (Torino). 1985 Mar-Apr;26(2):137-42.
Arteriovenous fistula formation has been advocated to increase the outflow for tibial and peroneal distal bypass grafts. Between January, 1981 and September, 1981, twenty-seven patients underwent thirty femoral to distal tibial or peroneal artery bypass procedures with creation of an arteriovenous fistula at the site of the distal anastomosis. Limb salvage was the primary indication for surgery in 97% of this severely ischemic group, with a mean ankle pressure index of 0.32. Despite high flow rates averaging 260 cc/minute and an initial patency rate of 97%, there were only two fistulas patent in intact limbs at the conclusion of the initial eight month follow-up period with one additional occlusion at 16 months. Limb salvage to the present (July 1983) was achieved in only six cases. In the patients with limb salvage, three bypass grafts remain patent despite fistula occlusion, two patients have occlusion of both graft and fistula but no rest pain, and a single patient has maintained both graft and fistula patency for 23 months. Creation of an arteriovenous fistula at the distal anastomotic site of tibial bypass procedures augments graft flow in the immediate post-op period; but, has very low long term patency rates and is not beneficial to graft patency or effectiveness.
动静脉瘘形成已被提倡用于增加胫动脉和腓动脉远端旁路移植术的流出道。在1981年1月至1981年9月期间，27例患者接受了30次股动脉至胫动脉远端或腓动脉的旁路手术，并在远端吻合口处创建了动静脉瘘。在这个严重缺血组中，97%的患者保肢是手术的主要指征，平均踝压指数为0.32。尽管平均血流量为260毫升/分钟且初始通畅率为97%，但在最初八个月的随访期结束时，完整肢体中仅有两个瘘保持通畅，在16个月时又有一例闭塞。截至目前（1983年7月），仅6例实现了保肢。在保肢的患者中，尽管瘘闭塞，但仍有三条旁路移植血管保持通畅，两名患者的移植血管和瘘均闭塞但无静息痛，一名患者的移植血管和瘘均保持通畅达23个月。在胫动脉旁路手术的远端吻合口处创建动静脉瘘在术后即刻可增加移植血管的血流量；但是，长期通畅率非常低，对移植血管的通畅性或有效性并无益处。
