Carpenter J P, Lieberman M D, Shlansky-Goldberg R, Braverman S E, Soulen M, Holland G A, Baum R A, Owen R S, Golden M A, Berkowitz H D
Department of Surgery, University of Pennsylvania School of Medicine.
J Vasc Surg. 1993 Jul;18(1):81-9. doi: 10.1067/mva.1993.41754.
When failure of vein grafts is due to technical error it is usually observed in the early postoperative period. In this review we describe late failure of five bypass grafts as a result of entrapment of the vein graft caused by an improperly placed tunnel from the femoral to the popliteal artery. Vein graft entrapment may either produce no symptoms or eventually lead to limb ischemia. Pulses and pressures that vary with flexion and extension maneuvers should alert the clinician to the possibility of an entrapment syndrome. The characteristic arteriographic findings observed in these patients include an aberrant course of the vein graft outside the anatomic course of the popliteal artery and position-dependent compression of the graft. The ability of magnetic resonance angiography to demonstrate the arteriographic appearance of the graft as well as the precise location of the compression and to identify structures involved in the entrapment, make it a valuable noninvasive tool in the preoperative assessment of these patients. Treatment options include division of the gastrocnemius muscle, division of the vein graft, or replacement of the vein graft. Familiarity with vein graft entrapment should facilitate its recognition. Careful placement of bypass grafts along the anatomic course of the popliteal artery within the popliteal space will prevent this complication.
当静脉移植物失败是由于技术失误时，通常在术后早期就会观察到。在本综述中，我们描述了5例旁路移植物的晚期失败，其原因是从股动脉到腘动脉的隧道放置不当导致静脉移植物受压。静脉移植物受压可能不产生任何症状，或最终导致肢体缺血。随屈伸动作而变化的脉搏和压力应提醒临床医生注意存在受压综合征的可能性。在这些患者中观察到的特征性血管造影表现包括静脉移植物在腘动脉解剖走行之外的异常走行以及移植物的位置依赖性受压。磁共振血管造影能够显示移植物的血管造影外观以及受压的精确位置，并识别参与受压的结构，这使其成为术前评估这些患者的一种有价值的非侵入性工具。治疗选择包括切断腓肠肌、切断静脉移植物或更换静脉移植物。熟悉静脉移植物受压情况应有助于其识别。在腘窝间隙内沿腘动脉的解剖走行仔细放置旁路移植物将预防这一并发症。
