Berlakovich G A, Herbst F, Mittlböck M, Kretschmer G
First Department of Surgery, University of Vienna, Austria.
Arch Surg. 1994 Mar;129(3):297-302. doi: 10.1001/archsurg.1994.01420270073017.
The choice of material for above-knee femoropopliteal bypass grafting is a matter of continuing controversy for various reasons. The most important argument in favor of alloplastic grafts is to preserve the autologous saphenous vein for a below-knee bypass, which might become indicated at a later date.
A consecutive series of above-knee reconstructions were analyzed with regard to long-term behavior. Early graft occlusions were not included, and the median follow-up was 83 months.
A university hospital with a particular interest in vascular surgery.
Four hundred forty-two patients received either autologous saphenous vein (n = 310) or alloplastic graft (n = 132) material, and were analyzed in a univariate (Kaplan-Meier) and multivariate (Cox) manner.
Analysis as to whether alloplastic graft material provides equal or less favorable results as compared with autologous saphenous vein material, in terms of primary and secondary patency, secondary below-knee bypass grafting, limb salvage, and survival.
Although univariate analysis demonstrated a significantly better primary patency rate for autologous saphenous vein material, multivariate analysis did not show any effect of the material in terms of patency, limb salvage, and survival. The frequency of secondary below-knee repair was 7% (31 patients); 56% were performed in the first 2 years postoperatively. This amounted to an estimated probability of 4.4% and 12.3% at 18 years, respectively.
The small probability of secondary below-knee repair in our series does not support the policy to use alloplastic grafts routinely for a primary above-knee bypass, to spare the saphenous vein. Therefore, patients should be offered the best material for the first operation even at the above-knee level.
由于多种原因，膝上股腘动脉搭桥移植材料的选择一直存在争议。支持使用人工血管移植物的最重要论据是保留自体大隐静脉用于膝下搭桥，因为日后可能需要进行膝下搭桥。
对一系列连续的膝上重建手术进行长期随访分析。不包括早期移植物闭塞情况，中位随访时间为83个月。
一家对血管外科有特殊兴趣的大学医院。
442例患者接受了自体大隐静脉（n = 310）或人工血管移植物（n = 132）材料，并采用单因素（Kaplan-Meier）和多因素（Cox）方法进行分析。
分析人工血管移植物材料与自体大隐静脉材料相比，在原发性和继发性通畅率、继发性膝下搭桥移植、肢体挽救和生存率方面是否提供相同或更差的结果。
虽然单因素分析显示自体大隐静脉材料的原发性通畅率明显更高，但多因素分析未显示材料在通畅率、肢体挽救和生存率方面有任何影响。继发性膝下修复的频率为7%（31例患者）；56%在术后头2年内进行。这相当于18年时估计概率分别为4.4%和12.3%。
在我们的系列研究中，继发性膝下修复的概率较小，不支持常规使用人工血管移植物进行原发性膝上搭桥以保留大隐静脉的策略。因此，即使在膝上水平，也应为患者提供首次手术的最佳材料。
