对股腘-胫自体静脉搭桥术进行强化监测可提高移植物长期通畅率并挽救肢体。

Intensive surveillance of femoropopliteal-tibial autogenous vein bypasses improves long-term graft patency and limb salvage.

作者信息

Bergamini T M, George S M, Massey H T, Henke P K, Klamer T W, Lambert G E, Miller F B, Garrison R N, Richardson J D

机构信息

Department of Surgery, University of Louisville School of Medicine, KY, USA.

出版信息

Ann Surg. 1995 May;221(5):507-15; discussion 515-6. doi: 10.1097/00000658-199505000-00008.

DOI:10.1097/00000658-199505000-00008

PMID:7748032

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1234628/

Abstract

OBJECTIVE

The authors determined the impact of an intensive surveillance program of autogenous vein bypasses on patency and limb salvage.

SUMMARY BACKGROUND DATA

Surveillance protocols of vein bypasses can identify graft-threatening lesions to permit elective revisions before thrombosis. The authors compared follow-up based on clinically indicated procedures with intensive surveillance.

METHODS

From 1985 to 1994, 615 autogenous vein bypasses (454 in situ, 161 reversed/composite) to popliteal (n = 169) and tibial (n = 446) arteries were performed for critical limb ischemia (n = 507), claudication (n = 88), and popliteal aneurysm (n = 20). Intensive surveillance of autogenous vein bypasses consisted of ankle brachial index and duplex scan with graft velocities measured at 1 month, 3 months, 6 months, and every 6 months subsequently. After surgery 317 bypasses had intensive surveillance, 222 bypasses were clinically indicated for follow-up, and 76 bypasses were excluded because follow-up or patency was less than 31 days.

RESULTS

Primary patency at 5 years was similar for bypasses treated by intensive surveillance (56%) and those treated with clinically indicated procedures (67%). Secondary patency and limb salvage at 5 years was significantly improved (p < 0.02) for bypasses followed by intensive surveillance (80% and 94%) compared with clinically indicated procedures (67% and 73%). Revision of patent bypasses was higher (p < 0.000001) for bypasses treated by intensive surveillance (61 of 70, 87%) compared with those treated with clinically indicated procedures (9 of 34, 26%). Secondary patency at 2 years was significantly higher (p < 0.02) for revision of patent bypasses (79%) compared with thrombosed bypasses (55%).

CONCLUSIONS

Long-term autogenous vein bypass patency and limb salvage is significantly improved by intensive surveillance, permitting identification and correction of graft threatening lesions before thrombosis.

摘要

目的

作者确定自体静脉搭桥强化监测方案对通畅率和肢体挽救的影响。

总结背景资料

静脉搭桥监测方案可识别威胁移植物的病变，以便在血栓形成前进行择期修复。作者比较了基于临床指征的随访与强化监测。

方法

1985年至1994年，对腘动脉（n = 169）和胫动脉（n = 446）进行了615例自体静脉搭桥手术（454例原位搭桥，161例翻转/复合搭桥），治疗严重肢体缺血（n = 507）、间歇性跛行（n = 88）和腘动脉瘤（n = 20）。自体静脉搭桥的强化监测包括踝臂指数和双功超声扫描，在术后1个月、3个月、6个月及随后每6个月测量移植物血流速度。术后317例搭桥接受强化监测，222例搭桥根据临床指征进行随访，76例搭桥因随访时间或通畅时间少于31天而被排除。

结果

强化监测组搭桥的5年原发性通畅率（56%）与临床指征组（67%）相似。强化监测组搭桥的5年继发性通畅率和肢体挽救率（分别为80%和94%）与临床指征组（分别为67%和73%）相比有显著改善（p < 0.02）。强化监测组搭桥（70例中的61例，87%）的通畅搭桥修复率高于临床指征组（34例中的9例，26%）（p < 0.000001）。通畅搭桥修复的2年继发性通畅率（79%）显著高于血栓形成搭桥（55%）（p < 0.02）。