Samson D S, Gewertz B L, Beyer C W, Hodosh R M
Arch Surg. 1981 Dec;116(12):1578-82. doi: 10.1001/archsurg.1981.01380240062009.
Saphenous vein interposition grafts of varying lengths have been used in 25 extracranial-intracranial bypasses since 1974. Indications for operation included transient ischemic episodes (13 cases), prophylactic augmentation of middle cerebral artery (MCA) collateral flow prior to surgical treatment of intracranial aneurysm (four), and traumatic occlusion of cervical or intracranial internal carotid arteries (eight). Vein grafts to cortical branches of MCA originated from superficial temporal or occipital arteries in ten cases, common or external carotid arteries in ten, and subclavian or innominate vessels in five. Twenty-one patients have been followed up for a minimum of 12 months. Immediate patency rate was 84%; one late graft occlusion decreased overall patency to 80%. There was one operative mortality. Early technical problems, including donor-recipient size disparity, anastomotic distortion, and inappropriate graft routing, have been overcome by the use of 2-mm veins, the avoidance of hydrostatic dilation, and the construction of retroauricular tunnels. It is reasonable to assume that long-term patency of these reconstructions will parallel that of extracranial-intracranial bypasses using autologous arteries.
自1974年以来，不同长度的大隐静脉移植已用于25例颅外-颅内搭桥手术。手术适应证包括短暂性缺血发作（13例）、颅内动脉瘤手术治疗前预防性增加大脑中动脉（MCA）侧支血流（4例）以及颈段或颅内颈内动脉创伤性闭塞（8例）。移植至MCA皮质支的静脉移植物，10例起源于颞浅动脉或枕动脉，10例起源于颈总动脉或颈外动脉，5例起源于锁骨下动脉或无名血管。21例患者接受了至少12个月的随访。即时通畅率为84%；1例晚期移植物闭塞使总体通畅率降至80%。有1例手术死亡。早期技术问题，包括供体-受体大小差异、吻合口变形和移植物走行不当，已通过使用2毫米静脉、避免流体静力扩张以及构建耳后隧道得以克服。可以合理推测，这些重建的长期通畅情况将与使用自体动脉的颅外-颅内搭桥手术相当。
