Comparative decades of experience with glutaraldehyde-tanned human umbilical cord vein graft for lower limb revascularization: An analysis of 1275 cases
Comparative decades of experience with glutaraldehyde-tanned human umbilical cord vein graft for lower limb revascularization: An analysis of 1275 cases
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DOI：
10.1067/mva.2002.121053
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发表时间：
2002-01-01
影响因子：
4.3
通讯作者：
Ibrahim, IM
中科院分区：
文献类型：
--
作者：
Dardik, H;Wengerter, K;Ibrahim, IM
目的：自首次下肢血运重建手术以来，生物材料一直被用作自体静脉的替代品。我们的经验与戊二醛脱鞣的人脐带静脉移植（UVg），其中跨越了28年的时间，形成了本报告的基础上，重点是比较结果之间的20年，从1975年至1985年和1990年至2000年。在1990年至2000年期间，在230名患者（264条肢体）中进行了283次下肢旁路移植术，UVg用作主要或唯一的移植材料。我们在1975年至1985年的十年中进行907次重建的经验以前已被记录在案，现在可以作为与过去十年UVg经验的基线比较。根据远端吻合部位是否有远端动静脉瘘（dAVF）对每次重建进行分类。根据累计缓解情况，结合移植物失败、截肢和死亡的终点，确定每种类型的一期和二期移植物通畅率。第二个十年（1990年至2000年）的结果表明，下肢血运重建中UVg移植物的通畅率持续提高。并发症的比较结果显示，感染、狭窄、夹层和假性动脉瘤的发生率无变化。原始系列结果显示2.9%需要动脉瘤手术，生物降解发生率为57%（36%动脉瘤，21%扩张），而当前系列结果显示迄今为止没有动脉瘤。对比既往和当前腘动脉和下肢旁路移植术（有或无dAVF）的6年二期通畅率：腘动脉，53% vs 67%，P
Purpose: Biological material has been used as an alternative to autogenous vein since the first lower extremity revascularization procedures were performed. Our experience with glutaraldehyde-tanned human umbilical cord vein graft (UVg), which spanned a period of 28 years, forms the basis of this report, with an emphasis on comparative results between the two decades from 1975 to 1985 and from 1990 to 2000.Methods. Between 1990 and 2000, 283 lower extremity bypass grafting procedures were performed in 230 patients (264 limbs), with UVg used as the predominant, or sole, graft material. Our experience with 907 reconstructions in the decade from 1975 to 1985 has been previously documented and now serves as a baseline comparison with the past decade of experience with UVg. Each reconstruction was classified on the basis of the distal anastomotic site with or without distal arteriovenous fistulas (dAVFs). The primary and secondary graft patency rates were determined for each category as was cumulative palliation, which combines the end points of graft failure, amputation, and death.Results. The results from the second decade (1990 to 2000) showed a continuation of improving patency rates for UVg grafts in lower extremity revascularization. Comparison results of complications showed no changes in the tow incidence rates of infection, stenosis, dissection, and pseudoaneurysm. The original series results showed a 2.9% requirement for aneurysm surgery, with an incidence rate of biodegradation of 57% (36% aneurysms, 21% dilation), whereas the current series results have shown no aneurysms to date. The comparative 6-year secondary patency rates for past and current popliteal and crural bypass grafts (with or without dAVF) were: popliteal, 53% versus 67%, P