Donaldson M C, Whittemore A D, Mannick J A
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
J Vasc Surg. 1993 Jul;18(1):41-8. doi: 10.1067/mva.1993.41958.
Between 1985 and 1991 a policy of strong preference for autogenous methods of infrainguinal reconstruction was followed to assess the efficacy of this strategy.
A total of 585 autogenous infrainguinal reconstructions were performed on 537 limbs in 448 patients between 1985 and 1991. Thirty-eight additional revascularizations were performed with prosthetic materials and seven patients underwent primary amputation during this interval. Of the autogenous reconstructions, 74% were primary and 26% were secondary procedures, 71% were for limb salvage, and 48% were to infrapopliteal arteries. Greater saphenous vein was used for 447 bypass grafts. Other autogenous methods included bypass with lesser saphenous (21), arm (20), and composite (30) veins, endarterectomy of the common femoral (18) and superficial femoral (40) arteries, and isolated profundaplasty (9).
Major operative morbidity occurred in 41 patients (7%), early graft failure in 47 (8%), and death in 12 (2%). At 5 years, the overall cumulative primary patency rate was 63% and the secondary patency rate was 72%. The 5-year secondary patency rate for the subgroup in which greater saphenous vein was used was 79% and for alternative autogenous methods the rate was 49% (p < 0.001). During the period of follow-up, major amputation was performed in 45 (7.9%) of the operated limbs.
This experience supports continued preferential use of autogenous methods for infrainguinal reconstruction.
在1985年至1991年期间，遵循了一项强烈倾向于采用自体方法进行股下重建的政策，以评估该策略的疗效。
1985年至1991年期间，对448例患者的537条肢体进行了总共585次自体股下重建。在此期间，另外进行了38次使用人工材料的血管重建，7例患者接受了一期截肢。在自体重建中，74%为一期手术，26%为二期手术，71%是为了挽救肢体，48%是针对腘下动脉。大隐静脉用于447例旁路移植。其他自体方法包括使用小隐静脉（21例）、上肢静脉（20例）和复合静脉（30例）进行旁路移植；股总动脉（18例）和股浅动脉（40例）的内膜切除术；以及单独的股深动脉成形术（9例）。
41例患者（7%）发生了严重手术并发症，47例（8%）出现早期移植物失败，12例（2%）死亡。5年时，总体累积一期通畅率为63%，二期通畅率为72%。使用大隐静脉的亚组5年二期通畅率为79%，其他自体方法的通畅率为49%（p<0.001）。在随访期间，45条（7.9%）手术肢体进行了大截肢。
该经验支持继续优先使用自体方法进行股下重建。
