Bonardelli S, Tiberio G A, Cangiotti L, Coniglio A, Pulcini G, Nodari F, Codignola C, Giulini S M, Tiberio G
Cattedra di Chirurgia Generale I, Università degli Studi di Brescia.
Ann Ital Chir. 1995 Mar-Apr;66(2):243-8; discussion 248-9.
The authors evaluate the indications, the hemodynamical aspects, the short and medium term results over their track record of 49 crossover bypass (44 dacron and 5 PTFE grafts) performed between 1981 and 1993. Crossover bypass grafts were mainly inserted for unilateral iliac arterial disease in order to avoid aortic manipulation. This procedure was particularly selected when in presence of: young patients (< 60 years old), high surgical risk, poor run-off, high risk of prosthetic infection, thrombosis and/or infection of orthotopic grafts. 3 ilio-iliac, 27 iliofemoral, 18 femorofemoral and 1 femoropopliteal bypass have been performed. The postoperative resting pressure Index increase was highly significant in recipient limbs. There wasn't perioperative mortality; during the follow up (mean 24.4 months) no amputation of recipient limb was observed. 4 patients died of A.M.I. and 1 of neoplastic disease. Late cumulative patency rate was 81% at 2 years and 67.3% at 3 years. These values rise to 97.2% and 86.1% respectively when considering patients with "ideal" indication (excluding 7 patients operated on for complications of previous bypass grafts and 6 with extremely poor run-off). An accurate evaluation of the lesion topography and haemodynamic pattern of donor and recipient iliofemoral districts are stressed as key points for a correct surgical indication.
作者评估了1981年至1993年间进行的49例交叉旁路移植术（44例使用涤纶移植物，5例使用聚四氟乙烯移植物）的适应证、血液动力学情况以及短期和中期结果。交叉旁路移植术主要用于单侧髂动脉疾病，以避免对主动脉进行操作。当存在以下情况时特别选择该手术：年轻患者（<60岁）、手术风险高、流出道差、人工血管感染风险高、原位移植物血栓形成和/或感染。已进行了3例髂-髂旁路、27例髂-股旁路、18例股-股旁路和1例股-腘旁路移植术。术后受区肢体静息压力指数升高非常显著。无围手术期死亡；在随访期间（平均24.4个月），未观察到受区肢体截肢。4例患者死于急性心肌梗死，1例死于肿瘤疾病。2年时晚期累积通畅率为81%，3年时为67.3%。当考虑具有“理想”适应证的患者时（不包括7例因先前旁路移植术并发症而手术的患者和6例流出道极差的患者），这些值分别升至97.2%和86.1%。强调对供体和受体髂股区病变形态和血流动力学模式进行准确评估是正确手术适应证的关键点。
