Petersen M J, Hines G
Department of Surgery, Winthrop University Hospital, Mineola, New York 11501.
Cardiovasc Surg. 1994 Apr;2(2):249-53.
Autologous saphenous vein is the preferred conduit for infrainguinal reconstructions. Patients requiring secondary infrageniculate bypass represent a challenging surgical problem. Often, patients requiring such surgery have had multiple bypass operations and lack usable saphenous vein. These patients may also be older and have complicated medical problems which may limit their total life expectancy. This report reviews 11 such patients who required secondary bypass procedures for limb salvage. All procedures were performed with thin-walled polytetrafluoroethylene (PTFE). No perioperative complications or deaths occurred. Four patients have subsequently died due to unrelated disease at 8, 12, 13, and 29 months after operation with clinically patent grafts. In the seven surviving patients, four grafts remain patent with a mean (s.d.) patency of 27(21) months. Three grafts occluded at 2, 4 and 20 months after surgery. By life table analysis, cumulative graft patency was therefore 68% at 24 months. It is concluded that in this high-risk population when no saphenous vein is available, PTFE may provide acceptable limb salvage when used in secondary infrageniculate reconstructions.
自体大隐静脉是腹股沟下血管重建的首选管道。需要进行二次膝下旁路手术的患者是一个具有挑战性的外科问题。通常，需要进行此类手术的患者已经接受过多次旁路手术，并且没有可用的大隐静脉。这些患者可能年龄较大，并且有复杂的医疗问题，这可能会限制他们的总预期寿命。本报告回顾了11例需要进行二次旁路手术以挽救肢体的患者。所有手术均使用薄壁聚四氟乙烯（PTFE）进行。围手术期无并发症或死亡发生。4例患者术后8、12、13和29个月因无关疾病死亡，移植血管临床通畅。在7例存活患者中，4例移植血管保持通畅，平均（标准差）通畅时间为27（21）个月。3例移植血管在术后2、4和20个月闭塞。通过生命表分析，因此24个月时移植血管的累积通畅率为68%。结论是，在这个没有大隐静脉可用的高风险人群中，当用于二次膝下重建时，PTFE可能提供可接受的肢体挽救效果。
