Miller A, Marcaccio E J, Tannenbaum G A, Kwolek C J, Stonebridge P A, Lavin P T, Gibbons G W, Pomposelli F B, Freeman D V, Campbell D R
Harvard-Deaconess Surgical Service, Division of Vascular Surgery, New England Deaconess Hospital, Boston, MA.
J Vasc Surg. 1993 Feb;17(2):382-96; discussion 396-8. doi: 10.1067/mva.1993.42067.
This study was designed to determine whether, in primary infrainguinal bypass grafts in which only saphenous vein is used as the graft conduit, routine monitoring with intraoperative angioscopy can improve early graft patency as compared with standard monitoring with intraoperative completion angiography; and to delineate the advantages and disadvantages of these two modalities and their respective roles for the routine monitoring of the infrainguinal bypass graft.
A total of 293 patients undergoing primary saphenous vein infrainguinal bypass grafting were prospectively randomized and monitored with either completion angioscopy or completion angiography. Clinical parameters, indications for operation, graft anatomy, and configuration were evenly matched in both groups. Forty-three bypasses were excluded from the study after randomization, including 12 veins randomized to angiogram, deemed inferior, and prepared with angioscopy.
In the 250 bypass grafts (angioscopy 128, angiography 122) there were 39 interventions (conduit, 29; anastomosis, 8; distal artery, 2), 32 with angioscopy and 7 with angiography (p < 0.0001). Twelve (4.8%) of the 250 grafts failed in less than 30 days, four (3.1%) of 128 in the angioscopy group and eight (6.6%) of 122 in the angiography group (p = 0.11 by one-sided hypothesis test).
Although no statistical improvement in the proportions of failures in primary saphenous vein bypass grafts routinely monitored with completion angioscopy rather than the standard completion angiogram was demonstrated, the study delineates a trend that favors completion angioscopy for routine vein graft monitoring and demonstrates the advantages of angioscopy in preparing the optimal vein conduit.
本研究旨在确定，在仅使用大隐静脉作为移植管道的原发性股腘动脉搭桥术中，与术中完成血管造影的标准监测相比，术中血管内镜的常规监测是否能提高早期移植血管通畅率；并阐明这两种监测方式的优缺点及其在股腘动脉搭桥术中常规监测的各自作用。
共有293例行原发性大隐静脉股腘动脉搭桥术的患者被前瞻性随机分组，并分别接受完成血管内镜检查或完成血管造影监测。两组的临床参数、手术指征、移植血管解剖结构和形态均匹配。随机分组后，43例搭桥术被排除在研究之外，其中包括12例随机分配至血管造影组、被认为质量较差而改用血管内镜检查的静脉。
在250例搭桥术中（血管内镜组128例，血管造影组122例），共进行了39次干预（管道，29次；吻合口，8次；远端动脉，2次），血管内镜组32次，血管造影组7次（p<0.0001）。250例移植血管中有12例（4.8%）在30天内失败，血管内镜组128例中有4例（3.1%），血管造影组122例中有8例（6.6%）（单侧假设检验，p=0.11）。
虽然与标准的完成血管造影相比，术中血管内镜常规监测的原发性大隐静脉搭桥术失败比例并无统计学上的改善，但本研究显示了一种倾向于术中血管内镜进行常规静脉移植血管监测的趋势，并证明了血管内镜在准备最佳静脉管道方面的优势。
