Chalmers R T, Synn A Y, Hoballah J J, Sharp W J, Kresowik T F, Corson J D
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1086.
Am J Surg. 1993 Aug;166(2):141-5. doi: 10.1016/s0002-9610(05)81045-1.
The value of post-reconstruction intraoperative angiography after in situ saphenous vein bypass has not been clearly defined. A retrospective review of intraoperative completion angiography using a standard proximal bypass injection technique without inflow occlusion was performed on 298 in situ saphenous vein bypasses constructed over a 72-month interval to treat critically ischemic limbs. Abnormal operative angiograms were found on retrospective review in 55 cases (18%). Minor abnormalities such as distal arterial or vein conduit spasm (class I defects) were found in 26 bypasses (9%) and required no surgical intervention. An anastomotic buckle or extrinsic compression due to an adventitial band (class II defect) was seen in five bypasses (2%). Defects requiring a major surgical revision (class III) were seen in 24 instances (8%). These abnormalities included nine cases with intraluminal platelet thrombus and six with a significant anastomotic torsional abnormality. In addition, there were five bypasses anastomosed to unsuitable diseased segments of distal arteries. Three of 24 (12%) of the bypasses with class III angiographic abnormalities required further revision within the first month after surgery, after duplex scanning had identified hemodynamically significant abnormalities, compared with 14 of 274 (5%) early revisions of the remaining in situ bypasses. The 30-day primary patency rate for bypasses with class III angiographic abnormalities was 88%. This compares with a rate of 95% for the remaining bypasses. The difference was not statistically significant. The 30-day and 48-month secondary patency rates for bypasses undergoing an immediate intraoperative revision for a class III abnormality were 100% and 93%, respectively. These rates were equivalent to the secondary patency of the in situ bypasses without class III abnormalities. Although the incidence of significant (class II and class III) angiographic abnormalities was low (10%), these abnormal findings allowed immediate correction of a jeopardized bypass, with minimal sequelae.
原位大隐静脉旁路术后重建术中血管造影的价值尚未明确界定。对298例采用标准近端旁路注射技术且未进行流入道阻断的原位大隐静脉旁路术进行回顾性研究，这些手术在72个月的时间间隔内进行，用于治疗严重缺血肢体。回顾性分析发现55例（18%）手术血管造影异常。26例旁路（9%）发现轻微异常，如远端动脉或静脉导管痉挛（I类缺陷），无需手术干预。5例旁路（2%）可见吻合口扣压或外膜带引起的外部压迫（II类缺陷）。24例（8%）存在需要进行重大手术修正的缺陷（III类）。这些异常包括9例管腔内血小板血栓形成和6例明显的吻合口扭转异常。此外，有5例旁路吻合至远端动脉的不合适病变节段。24例III类血管造影异常的旁路中有3例（12%）在术后第一个月内需要进一步修正，这是在双功扫描确定血流动力学显著异常之后，而其余原位旁路中274例有14例（5%）进行了早期修正。III类血管造影异常的旁路30天原发性通畅率为88%。其余旁路的这一比率为95%。差异无统计学意义。因III类异常而立即进行术中修正的旁路30天和48个月的继发性通畅率分别为100%和93%。这些比率与无III类异常的原位旁路的继发性通畅率相当。尽管显著（II类和III类）血管造影异常的发生率较低（10%），但这些异常发现可立即纠正处于危险中的旁路，且后遗症最少。
