THE ORIGIN OF INFRAINGUINAL VEIN GRAFT STENOSIS - A PROSPECTIVE-STUDY BASED ON DUPLEX SURVEILLANCE
THE ORIGIN OF INFRAINGUINAL VEIN GRAFT STENOSIS - A PROSPECTIVE-STUDY BASED ON DUPLEX SURVEILLANCE
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DOI：
10.1016/s0741-5214(95)70240-7
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发表时间：
1995-01-01
影响因子：
4.3
通讯作者：
LOGERFO, FW
中科院分区：
文献类型：
--
作者：
MILLS, JL;BANDYK, DF;LOGERFO, FW
目的：本研究的目的是根据对135例腹股沟下静脉旁路的前瞻性双重监测，确定静脉移植物病变的起源及其进展倾向。116例大隐静脉、13例拼接静脉、5例头静脉和1例股浅静脉移植物在手术过程中、1周和6周、3个月和6个月时通过彩色多普勒成像进行评价，此后每3至6个月一次。多普勒确定的病变进行了分级的收缩期峰值流速和流速比标准，要么遵循或进行revision.Results：术后早期多普勒监测允许腹股沟下移植物分层成两个子集。在早期扫描正常（3个月时）的91例（67%）移植物中，仅2例（2.2%）发生了需要翻修的新发狭窄（6个月和8个月时）。44例双功扫描异常的移植物在移植物主体（n = 24）或吻合口区域（n = 20）有局灶性血流异常（收缩期峰值流速> 150 cm/sec，流速比> 1.5）。在14个移植物中，血流异常（平均收缩期峰值流速= 217 cm/sec，流速比= 2.3）正常化。另外10个移植物显示中度、持续性移植物狭窄（平均收缩期峰值流速248 cm/sec，流速比= 3.3），未修复。所有20个病变进展为高度狭窄（平均收缩期峰值流速= 362 cm/sec，流速比= 7.2）并进行翻修的移植物在手术时证实存在残余血流异常，或在6周时出现。在整个系列中，6例（4.4%）移植物在平均12个月的随访间隔（范围3至30个月）内失败，4例未修复缺损，2例翻修后。
Purpose: The purpose of this study was to determine the origin of vein graft lesions and their propensity for progression based on prospective duplex surveillance of 135 infrainguinal vein bypasses.Methods: One hundred sixteen greater saphenous, 13 spliced, five cephalic, and one superficial femoral vein grafts were evaluated by color duplex imaging at surgical procedure, 1 and 6 weeks, 3 and 6 months, and every 3 to 6 months thereafter. Duplex-identified lesions were graded by peak systolic velocity and velocity ratio criteria and were either followed or subjected to revision.Results: Early postoperative duplex surveillance allowed stratification of infrainguinal grafts into two subsets. Of 91 (67%) grafts with normal early scans (at 3 months), only two (2.2%) developed de novo stenoses (at 6 and 8 months) that required revision. Forty-four grafts with abnormal duplex scans had a focal how abnormality (peak systolic velocity > 150 cm/sec, velocity ratio > 1.5) in the graft body (n = 24) or anastomotic region (n = 20). In 14 grafts the flow abnormality (mean peak systolic velocity = 217 cm/sec, velocity ratio = 2.3) normalized. Ten additional grafts exhibited a moderate, persistent graft stenosis (mean peak systolic velocity 248 cm/sec, velocity ratio = 3.3) that was not repaired. All 20 grafts with lesions that progressed to high-grade stenosis (mean peak systolic velocity = 362 cm/sec, velocity ratio = 7.2) and were revised had a residual flow abnormality confirmed at operation, or it appeared by 6 weeks. In the entire series six (4.4%) grafts failed during the mean 12-month follow-up interval (range 3 to 30 months), 4 with unrepaired defects and two after revision.Conclusions: Prospective duplex surveillance verified that de novo graft stenosis was uncommon (