Morrison W A, Mitchell G M, Hickey M J
Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia.
J Hand Surg Am. 1998 Nov;23(6):1106-11. doi: 10.1016/S0363-5023(98)80024-5.
Two cases are described in which patients presented 16 and 17 years, respectively, after complete or incomplete amputation/replantation of the arm. In case 1, the patient complained of coldness, pain, and tingling in the replanted arm in the previous 24 hours and noticed that his fingers had gone white. Arteriography and subsequent surgery revealed obliteration of the vein graft (inserted in the distal brachial artery) by neointimal thickening and atherosclerotic plaque, which was confirmed in a subsequent morphologic examination. In case 2, the patient presented with discomfort and a pulsatile swelling on the inner aspect of his upper arm. Arteriography and surgery revealed an aneurysm in the previously inserted vein graft in the brachial artery, with some atherosclerotic degeneration. Both vein grafts were successfully replaced with a fresh autologous vein graft and the patients remain well several years later. The 2 cases suggest that as part of replantation surgery of a limb, it is essential to maintain postoperative clinical monitoring for signs of graft degeneration in all patients with long-term vein graft insertion.
本文描述了两例患者，分别在手臂完全或不完全截肢/再植术后16年和17年出现症状。在病例1中，患者在过去24小时内主诉再植手臂发冷、疼痛和刺痛，并注意到手指变白。血管造影及随后的手术显示，（插入肱动脉远端的）静脉移植物因内膜增生和动脉粥样硬化斑块而闭塞，后续形态学检查证实了这一点。在病例2中，患者上臂内侧出现不适和搏动性肿胀。血管造影和手术显示，肱动脉中先前插入的静脉移植物出现动脉瘤，并伴有一些动脉粥样硬化退变。两根静脉移植物均成功地被新鲜的自体静脉移植物替代，数年后患者情况良好。这两个病例表明，作为肢体再植手术的一部分，对所有长期植入静脉移植物的患者进行术后临床监测以发现移植物退变迹象至关重要。
