Clinical results of common strategies used to revise infrainguinal vein grafts
Clinical results of common strategies used to revise infrainguinal vein grafts
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DOI：
10.1016/s0741-5214(96)70036-8
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发表时间：
1996-12-01
影响因子：
4.3
通讯作者：
ODonnell, TF
中科院分区：
文献类型：
--
作者：
Sullivan, TR;Welch, HJ;ODonnell, TF
目的：腹股沟下旁路移植失败或使用溶解疗法重新开放移植褪色的患者代表了随后失败的高风险群体。先前的研究表明，作为纠正移植物病变的方法，静脉补片血管成形术和跳跃移植可能不如插入移植持久。我们的目标是评估各种技术策略移植物的价值，并评估这些变量如何影响累积移植物通畅率 (CGP)。方法：我们回顾性回顾了 58 名患者的 67 个移植物的临床病程、翻修解剖部位和翻修类型，这些患者从 1991 年到 1995 年至少接受了一次翻修。结果通过回归分析和 Kaplan-Meier 对 CGP 率（p 1 段）移植物的估计进行评估，总体情况5年CGP率为72%。主要用跳跃移植物修复的血流动力学显着远端吻合口狭窄的移植物（n=20，71% CGP 率）和仅在移植物体内发现狭窄的移植物（n=41，89% CGP 率）之间没有观察到 4 年 CGP 率存在差异。静脉补片血管成形术主要用于（但并非唯一）治疗局灶性移植体狭窄（n = 35），而介入移植物（n = 11）则保留用于更弥漫的狭窄； 3 年 CGP 率没有显着差异（分别为 94% 和 73%）。 结论：采用适当的翻修策略，有利于对移植体病变进行静脉补片血管成形术，对远端吻合病变进行跳跃移植，对于有反复失败风险的移植物，可以获得可接受的辅助通畅率。
Purpose: Patients who have failing infrainguinal bypass grafts or faded grafts reopened with lytic therapy represent a group at high risk of subsequent failure. Previous studies suggest that vein patch angioplasty and jump grafting may be less durable than interposition grafting as a method of correcting graft lesions. Our objective was to assess the value of various technical strategies grafts and to assess how these variables might affect cumulative graft patency (CGP) rates.Methods: We retrospectively reviewed the clinical course, anatomic sites of revision, and type of revision performed on 67 grafts in 58 patients who underwent at least one revision from 1991 to 1995. Results were assessed with regression analysis and Kaplan-Meier estimates of CGP rates (p 1 segment) grafts, with an overall 5-year CGP rate of 72%. No difference was observed between the 4-year CGP rate in grafts with hemodynamically significant distal anastomotic stenoses repaired primarily with jump grafts (n=20, 71% CGP rate) and those with stenoses found only in the graft body (n=41, 89% CGP rate). Vein patch angioplasty was used primarily, but not exclusively, for focal graft body stenoses (n=35), whereas interposition grafts (n=11) were reserved for more diffuse strictures; no significant difference in 3-year CGP rates was observed (94% and 73%, respectively).Conclusion: Using an appropriate revision strategy that favors vein patch angioplasty for graft body lesions and jump grafts for distal anastomotic lesions, acceptable assisted patency rates can be achieved in grafts that are at risk for repeated failure.