Dalman R L, Harris E J, Zarins C K
Department of Surgery, Palo Alto Veterans Affairs, CA, USA.
J Vasc Surg. 1996 Apr;23(4):637-44. doi: 10.1016/s0741-5214(96)80044-9.
Many surgeons advocate uniform performance of operative completion arteriography after leg bypass surgery to ensure technical success and to optimize short- and intermediate-term graft patency. To determine the impact of this practice on the outcome of reversed-vein bypass surgery and associated patient charges, we reviewed our series of consecutive nonemergent leg bypass procedures. Ninety-three infrainguinal bypass procedures were performed in 80 patients (76 men and 4 women) from September 1991 to August 1994. The patients' average age was 67 years (range, 30 to 92 years). Follow-up (mean, 113.1 months; range, 1 to 36 months) was available on 91 grafts (97%). Indications for surgery included limb salvage in 75 cases, claudication in 12 cases, and popliteal aneurysm exclusion in 6 cases. All patients survived surgery. Primary graft patency rates as determined by life-table analysis were 87%, 81%, 78%, and 78% at 6 months and at 1, 2, and 3 years, respectively. Limb-salvage rates were 95%, 91%, 87% and 87% at the same intervals. Bypass procedures were divided into two groups. The 25 grafts in group 1 were evaluated with inspection, continuous-wave Doppler insonation, and routine completion arteriography. The 68 grafts in group 2 were evaluated by inspection and insonation alone. Fourteen grafts occluded after surgery (average, 5 months; range, 1 to 12 months), five in group 1 and nine in group 2. The likelihood of graft occlusion was similar in both groups (p = 0.42). The optimal method of confirming technical adequacy after bypass surgery in the clinically satisfactory graft remains uncertain. Charges for completion arteriography at our institution average $700, including 15 minutes of additional operative time. In our experience, these charges do not appear to be justified by improved short- or intermediate-term graft patency rates in reversed-vein grafts when completion arteriography is performed.
许多外科医生主张在腿部搭桥手术后常规进行手术结束时的血管造影，以确保手术技术成功并优化短期和中期移植物通畅率。为了确定这种做法对静脉逆转搭桥手术结果及相关患者费用的影响，我们回顾了我们连续进行的一系列非急诊腿部搭桥手术。1991年9月至1994年8月，80例患者（76名男性和4名女性）接受了93例腹股沟下搭桥手术。患者的平均年龄为67岁（范围30至92岁）。91例移植物（97%）获得了随访（平均113.1个月；范围1至36个月）。手术指征包括75例肢体挽救、12例间歇性跛行和6例腘动脉瘤切除。所有患者均存活至手术结束。通过寿命表分析确定的原发性移植物通畅率在6个月时为87%，在1年、2年和3年时分别为81%、78%和78%。在相同时间间隔下，肢体挽救率分别为95%、91%、87%和87%。搭桥手术分为两组。第1组的25例移植物通过检查、连续波多普勒超声和常规手术结束时的血管造影进行评估。第2组的68例移植物仅通过检查和超声进行评估。14例移植物在术后闭塞（平均5个月；范围1至12个月），第1组5例，第2组9例。两组移植物闭塞的可能性相似（p = 0.42）。对于临床效果满意的移植物，搭桥手术后确认技术是否充分的最佳方法仍不确定。我们机构手术结束时血管造影的费用平均为700美元，包括额外15分钟的手术时间。根据我们的经验，当进行手术结束时的血管造影时，改善静脉逆转移植物的短期或中期通畅率似乎并不能证明这些费用是合理的。
