Nielsen T G, von Jessen F, Schroeder T V
Karkirurgisk afdeling RK, Rigshospitalet, København.
Ugeskr Laeger. 1993 Mar 22;155(12):881-4.
Identification and correction of graft stenoses in femoropopliteal and -crural vein bypasses can prevent reconstruction failure. Sixty six consecutive vein bypasses entered a postoperative surveillance protocol, which implied clinical assessment, measurement of ankle blood pressure and duplex-scanning every three months. In 15 cases the duplex-scanning indicated graft stenoses. Seven were revised, five of which remain patent after a median follow-up of three months. Eight stenoses were observed without intervention. Five of these uncorrected stenoses (63%) thrombosed and the function of the bypass could not be reestablished. Of the 34 bypasses with normal duplex-scans only 2 (6%) thrombosed (p < 0.01 compared to observed but not revised stenosis). Neither clinical evaluation or ankle blood pressure measurement could reliably predict graft failure. This study indicates that duplex-scanning effectively identifies grafts at risk and can be expected to improve long-term patency of infrainguinal vein bypasses.
识别并纠正股腘静脉和小腿静脉旁路移植血管的狭窄可预防重建失败。连续66例静脉旁路移植术进入术后监测方案，该方案包括临床评估、每三个月测量一次踝部血压以及进行双功超声扫描。在15例病例中，双功超声扫描显示移植血管狭窄。7例进行了修正，其中5例在中位随访三个月后仍保持通畅。观察到8例狭窄未进行干预。这些未纠正的狭窄中有5例（63%）发生血栓形成，旁路功能无法重建。在双功超声扫描正常的34例旁路移植术中，只有2例（6%）发生血栓形成（与观察到但未修正的狭窄相比，p<0.01）。临床评估或踝部血压测量均不能可靠地预测移植血管失败。本研究表明，双功超声扫描可有效识别有风险的移植血管，并有望提高股下静脉旁路移植术的长期通畅率。
