Harris P L, Veith F J, Shanik G D, Nott D, Wengerter K R, Moore D J
Department of Vascular Surgery, Broadgreen Hospital, Liverpool, UK.
Br J Surg. 1993 Feb;80(2):173-6. doi: 10.1002/bjs.1800800213.
A three-centre prospective randomized trial was undertaken to compare the efficacy of in situ and reversed saphenous vein grafts for long bypasses to tibial and peroneal arteries. Of 162 patients entered into the study, 82 received an in situ graft and 80 a reversed vein graft. All operations were for limb salvage and the two groups of patients were well matched for age, sex, incidence of diabetes, smoking habits and coronary artery disease. At a maximum follow-up of 3 years there were 48 primary graft failures: 19 in the in situ group and 29 in the reversed vein group. Of these, three in situ grafts and seven reversed grafts were salvaged by secondary intervention. Secondary cumulative patency rates calculated at 3 years after operation were 68 and 66 per cent respectively for in situ and reversed grafts (P not significant). Cumulative limb salvage rates were 78 per cent for in situ grafts and 87 per cent for reversed grafts (P not significant). Separate analysis of a subgroup with small veins (< or = 3.5 mm minimum diameter) showed cumulative patency rates at 2 years of 74 per cent for in situ grafts and 60 per cent for reversed grafts (P not significant). These results indicate that for veins > 3.5 mm in diameter the in situ and reversed techniques for operation are equally effective. Some doubt remains about the best way of using smaller veins; a large number of such veins need to be studied to resolve this question.
开展了一项三中心前瞻性随机试验，以比较原位和反转大隐静脉移植用于胫动脉和腓动脉长段旁路移植术的疗效。162例纳入研究的患者中，82例接受原位移植，80例接受反转静脉移植。所有手术均为保肢手术，两组患者在年龄、性别、糖尿病发病率、吸烟习惯和冠状动脉疾病方面匹配良好。最长随访3年时，有48例原发性移植失败：原位组19例，反转静脉组29例。其中，3例原位移植和7例反转移植通过二次干预挽救。术后3年计算的原位和反转移植的二次累积通畅率分别为68%和66%（P无显著性差异）。原位移植的累积保肢率为78%，反转移植为87%（P无显著性差异）。对小静脉（最小直径≤3.5 mm）亚组的单独分析显示，原位移植2年时的累积通畅率为74%，反转移植为60%（P无显著性差异）。这些结果表明，对于直径>3.5 mm的静脉，原位和反转手术技术同样有效。对于使用较小静脉的最佳方法仍存在一些疑问；需要研究大量此类静脉以解决这个问题。
