Sumner D S, Strandness D E
Surgery. 1979 Sep;86(3):442-52.
Thirty-ones limbs of 29 consecutive patients undergoing bypass grafts to the tibial or peroneal arteries were studied. Twenty-five limbs had ischemic rest pain with or without localized gangrene, and six had incapacitating claudication. The mean segmental pressure indices were upper thigh, 1.16 +/- 0.36; above knee, 0.71 +/- 0.30; below knee 0.51 +/- 0.23; and ankle, 0.28 +/- 0.21. Indices at the ankle were significantly lower (P less than 0.005) than those obtained from limbs that were candidates for simple femoropopliteal bypass. Three grafts failed immediately (initial patency rate of 90%). In the surviving grafts, ankle pressures rose from 39 +/- 26 to 145 +/- 29 mm Hg, and the ankle pressure index increased from 0.27 +/- 0.20 to 1.03 +/- 0.15 mm Hg. Consistent with these hemodynamic changes, all patients but one initially were relieved of their symptoms, and all ischemic lesions were treated successfully. Thirteen grafts failed subsequently (21 days to 34 months). Compared with preoperative values, ankle pressures after failure were either increased or unchanged in 75% of these limbs. Early occlusion could not be predicted on the basis of a low preoperative pressure index. During follow-up, impending graft failure was detected by a fall in ankle pressure in three patients and successfully prevented.
对29例连续接受胫动脉或腓动脉旁路移植术患者的31条肢体进行了研究。25条肢体有静息性缺血性疼痛，伴有或不伴有局部坏疽，6条肢体有导致失能的间歇性跛行。平均节段压力指数为：大腿上部1.16±0.36；膝上0.71±0.30；膝下0.51±0.23；踝部0.28±0.21。踝部指数明显低于（P<0.005）拟行单纯股腘动脉旁路移植术肢体的指数。3条移植物立即失败（初始通畅率90%）。在存活的移植物中，踝部压力从39±26mmHg升至145±29mmHg，踝部压力指数从0.27±0.20升至1.03±0.15mmHg。与这些血流动力学变化一致，除1例患者外，所有患者最初的症状均得到缓解，所有缺血性病变均得到成功治疗。13条移植物随后失败（21天至34个月）。与术前值相比，这些肢体中有75%在移植物失败后踝部压力升高或未变。不能根据术前低压力指数预测早期闭塞。在随访期间，3例患者通过踝部压力下降检测到移植物即将失败，并成功预防。
