Bush H L, Corey C A, Nabseth D C
Am J Surg. 1983 Apr;145(4):542-8. doi: 10.1016/0002-9610(83)90055-7.
Early failure remains a major obstacle to successful distal bypass surgery using vein grafts for limb salvage. Thirty distal bypass graft procedures were performed for limb salvage using the in situ technique. Grafts were anastomosed to the distal popliteal artery in 13 patients and to the infrapopliteal artery in 17 patients. Sixteen patients had inadequate saphenous veins for reversed vein grafts. The mean blood flow measured through these grafts (n = 20) was 164 +/- 22 ml/min and increased to 278 +/- 31 ml/min after administration of 30 mg of papaverine. All grafts were patent at the time of hospital discharge and patients were followed for 1 to 28 months. Life table analysis of the 30 procedures shows a patency of 100 percent at 18 months follow-up. One graft subsequently failed at 22 months. Long-term limb salvage was achieved in 100 percent of the patients in this series. The excellent blood flow through these grafts suggests that the in situ vein graft technique may be more favorable for arterial reconstruction than the reversed vein graft technique. Our preliminary data confirm the observations of Leather et al [3,4], that the rates of vein utilization and graft patency are higher with the in situ technique.
早期失败仍然是使用静脉移植物进行肢体挽救的远端搭桥手术成功的主要障碍。采用原位技术进行了30例用于肢体挽救的远端搭桥移植物手术。13例患者的移植物与腘动脉远端吻合，17例患者的移植物与腘动脉以下动脉吻合。16例患者的大隐静脉不适合用于逆向静脉移植物。通过这些移植物（n = 20）测得的平均血流量为164 +/- 22 ml/分钟，给予30 mg罂粟碱后增加至278 +/- 31 ml/分钟。所有移植物在出院时均通畅，患者随访1至28个月。对这30例手术的生命表分析显示，在18个月随访时通畅率为100%。随后有1例移植物在22个月时失败。该系列中100%的患者实现了长期肢体挽救。这些移植物良好的血流量表明，原位静脉移植物技术可能比逆向静脉移植物技术更有利于动脉重建。我们的初步数据证实了Leather等人[3,4]的观察结果，即原位技术的静脉利用率和移植物通畅率更高。
