Sasajima T, Kubo Y, Kokubo M, Izumi Y, Inaba M
First Department of Surgery, Asahikawa Medical College, Japan.
Cardiovasc Surg. 1993 Feb;1(1):38-43.
A series of 241 consecutive autogenous vein bypasses for chronic lower-limb ischaemia performed by two surgeons since 1980 was reviewed. After 1985, in situ vein bypass was employed preferentially and was compared with reversed vein bypass. The two groups of patients had similar risk factors, indications and outflow. Of the 241 bypasses, 157 were to the below-knee popliteal artery and 84 to infrapopliteal arteries. The utilization rates of a single ipsilateral saphenous vein were 57.5% for reversed and 71.9% for in situ vein bypass. However, in situ vein bypass was impossible in 43 procedures and these were changed to the reversed operation with contralateral vein. The primary 5-year patency rates of reversed and in situ vein bypass grafts to the popliteal artery were 82.5 versus 74.5%, and the primary 4-year patency rates for infrapopliteal bypass 68.5 versus 80.0%. The respective secondary patency rates were 94.2 versus 92.1% and 85.7 versus 91.1%. The main cause of graft failure was vein graft stenosis (reversed vein bypass, 13.0%; in situ, 11.1%), which usually occurred in the first 2 years after surgery. Of 23 grafts revised for stenosis, 21 were salvaged and restenosis rarely occurred. Both reversed and in situ vein bypass grafts were equally effective, but careful surveillance for 2 years and aggressive revision were extremely important after either type of reconstruction.
回顾了自1980年以来由两位外科医生为慢性下肢缺血进行的一系列241例连续自体静脉搭桥手术。1985年后，优先采用原位静脉搭桥，并与翻转静脉搭桥进行比较。两组患者的危险因素、适应症和流出道相似。在241例搭桥手术中，157例是到膝下腘动脉，84例是到腘动脉以下的动脉。单条同侧大隐静脉的利用率，翻转静脉搭桥为57.5%，原位静脉搭桥为71.9%。然而，有43例手术无法进行原位静脉搭桥，改为用对侧静脉进行翻转手术。翻转和原位静脉搭桥至腘动脉的5年原发性通畅率分别为82.5%和74.5%，腘动脉以下搭桥的4年原发性通畅率分别为68.5%和80.0%。各自的继发性通畅率分别为94.2%和92.1%，以及85.7%和91.1%。移植失败的主要原因是静脉移植狭窄（翻转静脉搭桥为13.0%；原位为11.1%），通常发生在术后的头2年。在因狭窄而进行翻修的23例移植中，21例得以挽救，再狭窄很少发生。翻转和原位静脉搭桥同样有效，但无论哪种重建方式后，进行2年的仔细监测和积极翻修都极为重要。
