Tordoir J H, van der Plas J P, Jacobs M J, Kitslaar P J
Department of Surgery, Academic Hospital Maastricht, The Netherlands.
Eur J Vasc Surg. 1993 Jan;7(1):82-6. doi: 10.1016/s0950-821x(05)80549-3.
The influences of clinical factors, site of distal anastomosis, type of graft and angiographic run-off, on graft patency and limb salvage following 141 femorocrural and pedal bypasses in 121 patients were investigated retrospectively. The grafts consisted of 111 femorocrural and 30 pedal bypasses; 49% of the patients had diabetes mellitus. Venous grafts were implanted in 116 limbs, using either in situ vein (65), reversed vein (38) or composite vein (13) graft. Twenty-five prosthetic grafts (14 PTFE and 11 umbilical veins) were inserted. After 1, 2, 3 and 4 years of follow-up, the primary cumulative patency rates for all grafts were respectively 67, 61, 55 and 55%, and the secondary patency rates were 75, 70, 64 and 64%. The site of distal anastomosis had no influence on graft patency rate; neither was there any significant effect of clinical risk factors and run-off on graft patency. Prosthetic grafts showed significantly lower patencies compared to venous grafts and appeared to be the only independent prognostic risk factor for graft failure (multivariate analysis; p = 0.03). Overall limb salvage rate was 84% at 3 years. There were four amputations with patent grafts. The limb salvage rates for in situ vein, reversed/composite vein and prosthetic grafts were 89, 79 and 66% at 3 years, respectively. Various bypass grafts to the crural and pedal arteries are successful and durable. The use of prosthetic grafts results in significantly lower patency rates, but appears to be effective for limb salvage.
回顾性研究了121例患者141次股腘和足部旁路手术中临床因素、远端吻合部位、移植物类型和血管造影流出情况对移植物通畅率和肢体挽救的影响。这些移植物包括111次股腘旁路手术和30次足部旁路手术；49%的患者患有糖尿病。116条肢体植入了静脉移植物，采用原位静脉（65条）、翻转静脉（38条）或复合静脉（13条）移植物。插入了25条人工血管移植物（14条聚四氟乙烯和11条脐静脉）。随访1、2、3和4年后，所有移植物的原发性累积通畅率分别为67%、61%、55%和55%，继发性通畅率分别为75%、70%、64%和64%。远端吻合部位对移植物通畅率没有影响；临床风险因素和流出情况对移植物通畅率也没有显著影响。与静脉移植物相比，人工血管移植物的通畅率显著较低，似乎是移植物失败的唯一独立预后风险因素（多变量分析；p = 0.03）。3年时总体肢体挽救率为84%。有4例截肢患者的移植物通畅。3年时原位静脉、翻转/复合静脉和人工血管移植物的肢体挽救率分别为89%、79%和66%。各种到小腿和足部动脉的旁路移植物是成功且持久的。人工血管移植物的使用导致通畅率显著降低，但似乎对肢体挽救有效。
