Alexander J J, Wells K E, Yuhas J P, Piotrowski J J
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio 44109, USA.
Am J Surg. 1996 Aug;172(2):118-22. doi: 10.1016/s0002-9610(96)00131-6.
In this study, the efficacy of composite sequential bypass is compared to that of standard in situ bypass, and to alternate prosthetic graft systems which have been used for the treatment of multilevel infrainguinal arterial occlusive disease in the absence of suitable autogenous vein.
A retrospective review of graft patency and limb salvage included 197 patients undergoing 211 bypass procedures consisting of in situ femoral-tibial (IS; n = 119); composite sequential (CS; n = 35), prosthetic femoropopliteal with single (PFP-1; n = 30) or no vessel runoff (PFP-O; n = 9), and prosthetic femoral-tibial (PFT; n = 18) bypass.
By life-table analysis, IS bypass provided superior primary (P < 0.005) and secondary (P < 0.0005) patency over the other groups. CS bypass was similar to PFP-1, with a 2-two year primary patency of 35% and 44% (NS), respectively, and limb salvage rates of 60% and 80% (P = 0.01). PFP-O and PFT bypass procedures did considerably worse, with a 1-year patency of 19% and 22%, respectively, and associated limb salvage rates of 25% and 41% (NS).
Composite sequential bypass is an acceptable procedure for infrainguinal arterial reconstruction when absence of autogenous vein prevents either in situ or secondary vein graft bypass procedures.
在本研究中，将复合序贯搭桥术的疗效与标准原位搭桥术以及在缺乏合适自体静脉时用于治疗多节段股下动脉闭塞性疾病的替代人工血管系统的疗效进行比较。
对移植物通畅率和肢体挽救情况进行回顾性研究，纳入了197例患者，共进行了211例搭桥手术，包括原位股-胫搭桥（IS；n = 119）；复合序贯搭桥（CS；n = 35），单支人工血管股-腘搭桥（PFP-1；n = 30）或无血管流出道人工血管股-腘搭桥（PFP-O；n = 9），以及人工血管股-胫搭桥（PFT；n = 18）。
通过寿命表分析，原位搭桥在原发性（P < 0.005）和继发性（P < 0.0005）通畅率方面优于其他组。复合序贯搭桥与单支人工血管股-腘搭桥相似，2年原发性通畅率分别为35%和44%（无显著性差异），肢体挽救率分别为60%和80%（P = 0.01）。无血管流出道人工血管股-腘搭桥和人工血管股-胫搭桥手术效果明显较差，1年通畅率分别为19%和22%，相关肢体挽救率分别为25%和41%（无显著性差异）。
当缺乏自体静脉而无法进行原位或二次静脉移植物搭桥手术时，复合序贯搭桥是股下动脉重建的一种可接受的手术方法。
