Early results of femoropopliteal bypass using a five millimeter «thin wall» polytetrafluoroethylene (Gore-Tex) prosthesis

We report the early results of a series of 86 femoropopliteal bypass operations in which a 5 mm diameter thin wall polytetrafluoroethylene (Gore-Tex) prosthesis was used. Sixty-five bypasses were implanted in men and 21 in women. Thirty bypasses were done in conjunction with an aortic bifurcation graft and 18 patients had a bilateral procedure. The indication for operation was severe claudication in 74 cases and critical ischaemia in 12 cases. The angiographic run-off was good (three patent vessels) in 22 limbs and poor (one or two patent vessels) in 64 limbs. The cumulative patency rate for the whole group was 62% after 18 months. Angiographic run-off and the indication for operation were both found to influence cumulative patency rate significantly (p=0.035 and p=0.055, respectively). We also compared the results obtained when run-off was poor with equivalent data from our own previously published series in which a standard 6 mm diameter Gore-Tex prosthesis was used. This shows a difference in patency rate, for example 57% against 37% after 18 months, in favour of the smaller bore thin wall graft.     

Perigraft seroma following axillofemoral bypass: Report of three cases

One hundred and twenty-three axillofemoral or bifemoral bypasses were performed in the Department of Cardiovascular and Thoracic Surgery of the Catholic University of Louvain, Belgium between 1975 and 1986. Three cases of perigraft seroma were noted. A polytetrafluoroethylene (PTFE) graft had been inserted in all three cases. In one case, the seroma recurred rapidly after surgical drainage. The two others were not drained. In all three cases appearance remained unchanged throughout the observation period. The three bypasses are patent at 5, 14 and 24 months. Observation is advocated for this complication especially in high risk patients.     

Femoropopliteal in situ saphenous vein bypass: Technical aspects and factors determining patency

The results and the factors influencing long-term patency rates in two technical variations of femoropopliteal «in situ» saphenous vein bypass procedures were evaluated retrospectively. Technique I (n=33) consisted of a limited approach to the saphenous vein, destruction of the valves with a Cartier stripper and no tributary ligation. Technique II (n=55) included complete exposure of the saphenous vein valvular destruction using Hall’s stripper and ligation of all tributaries. Early thrombosis was observed in 21% and 3.6% of cases in techniques I and II, respectively. The frequency of local complications was identical in both techniques (18%). Overall actuarial primary patency at 4 years was 70%. Secondary patency (including patency following reoperations for graft failure) was 88 % overall, 78.5% in technique I and 95% in technique II (p<0.05). The site of the distal anastomosis significantly influenced the four year cumulative patency rate (upper popliteal ?100%, lower popliteal ?93.6%, tibioperoneal vessels ?70.5%, p<0,05), whereas the number of patent leg vessels, the clinical stage of disease and the site of the proximal anastomosis (common femoral or superficial fernoral artery) did not. Results obtained with the in situ saphenous vein bypass using technique II were better than with technique I. Close follow-up and preventive reoperations clearly enhanced patency rates. The site of distal anastomosis significantly affected long-term results.     

A five-to seven-year experience with externally-supported Dacron prostheses in axillofemoral and femoropopliteal bypass

We have examined the clinical results of 56 externally-supported (EXS) Dacron grafts in the axillofemoral position and 117 in the femoropopliteal position. Results have been analyzed from two perspectives: primary patency concerns only those grafts that had never occluded; extended patency refers to all open grafts including those whose continued patency is the result of thrombectomy. The 5-to 7-year life-table patency rates are: axillofemoral 8 mm and 6 mm bypass: primary 75% and extended 97%; above-knee femoropopliteal 6 mm bypass: primary 78% and extended 93%; below-knee 6 mm femoropopliteal bypass: primary 41% and extended 91%. In contrast, the results for the 5 mm grafts used for femoropopliteal bypass were inferior to the 6 mm grafts: femoropopliteal 5 mm bypasses had an above-knee primary patency rate of 44% and an extended rate of 55%, with a below-knee primary patency rate of 15% and an extended rate of 32%. Rendering the noncrimped porous Dacron prosthesis kink and compression resistant by an external support coil appears to increase its potential for successful use, especially in 8 mm axillofemoral and 6 mm femoropopliteal bypasses. Presented to the Western Vascular Society, January 1986, Laguna Niguel, California.     

Combined aortobifemoral and femoropopliteal bypass in the management of patients with extensive atherosclerosis

Certain patients have atherosclerosis in both aortoillac and femoropopliteal segments of the arterial tree and thus do not have a good result from reconstruction of the aortoiliac segment. No method has been developed to identify these patients and we do not know whether, by combining a femoropopliteal bypass with an aortobifemoral bypass, the results can be improved. We present a series of 153 patients with severe multilevel occlusive disease treated by simultaneous reconstruction and followed for up to 6.5 years. The cumulative patency of the femoropopliteal bypasses was 80% at four years. Functional and symptomatic improvement was excellent, and operative mortality was low when one considers the age and poor general condition of the patients.     

The human umbilical vein graft in below-knee femoropopliteal and femorotibial surgery: an eight year experience

The authors present a series of 175 femoropopliteal (below-knee) and 65 femorotibial reconstructions with the human umbilical vein (HUV) graft performed over an eight year period. With a mean follow-up of 36.7 months (range one month to 84 months) the early patency rate of 89% decreased to 54% after five years. Longterm patency was found to be primarily related to the location of the distal anastomosis and the quality of the outflow, showing a statistically significant decrease after repeat revascularization. Early thrombosis, even in the absence of a technical failure and late aneurysmal degeneration remain the major problems associated with the use of the HUV graft. It is therefore recommended that these reconstructions be preserved for patients with advanced ischemia or a limited life-expectancy.     

乳内动脉-冠状动脉旁路移植术53例

作者对１９９４年１月～１９９６年１２月本院所作的５３例乳内动脉（ＩＭＡ）－冠状动脉旁路移植术进行了总结。全部患者均为经内科治疗效果不满意者。其中４４例发生过一次以上的心肌梗塞；１６例合并室壁瘤形成。除１例为非体外循环行单纯左ＩＭＡ与左前降支吻合外，其余均行左ＩＭＡ吻合前降支及大隐静脉序惯“蛇形”桥。全组平均做冠脉吻合口４．２８支。同期左室室壁瘤切除４例。手术死亡４例。３５例随访６个月～１年半，其中３０例症状消失，５例症状减轻，活动量增加。随访结果提示，ＩＭＡ冠脉旁路移植术可取得满意疗效。作者还对ＩＭＡ冠脉旁路移植术的技术要点、适应证等进行了讨论。     

股浅静脉闭塞症手术治疗的初步评价

目的：评价股浅静脉闭塞症的手术治疗。方法：1988年3月－2000年12月，采用原位大隐静脉－Guo静脉转流（Husni's）手术治疗股浅静脉闭塞症共8例。结果：6例（6／8）获得长期随访，平均随访74个月。2例转流静脉通畅，临床症状明显好转或基本消失；4例闭塞、肿胀加重但未出现溃疡等严重并发症。结论：Husni's手术宜慎重且合理地选择病人。Husni's手术宜选择病程较短、患肢腓肠股泵功能尚未严重受损的病例；压力辅助治疗是十分重要的。     

15 cases of femoro-popliteal bypass with PTFE graft

The authors report their clinical experience of 15 cases of femoro-popliteal by-pass with PTFE; all patients underwent postoperative anti-platelet therapy, in 8 cases with ASA and dipyridamole, in 7 with indobufene in accordance with a double blind randomized work. The Authors report the results of a one year follow-up. They deal with patency duration results and tolerance of pharmacological treatment.     

In situ versus reversed saphenous vein for femoropopliteal bypass: a prospective randomized study of 100 cases

With the purpose of comparing results using the greater saphenous vein in situ or as a reversed conduit, 100 femoropopliteal bypasses, performed in 91 patients between October 1980 and January 1985, were randomized into two statistically comparable groups of 50 procedures of each type. Seventy-five percent of patients had cutaneous signs of ischemia and 20% had isolated rest pain. Average follow-up was 32 months for the in situ group and 33.4 months in the reversed bypass group. The quality of the vein was statistically better in the in situ group (p<0.01). There were six cases of early thrombosis in the in situ group compared to four in the reversed bypass group. In the in situ group, half of the thromboses could be attributed to inadequate valviar destruction. Seven delayed thromboses were noted in the in situ group whereas there were two in the reversed saphenous vein bypass group. The actuarial rates of bypass patency at three years in the reversed and in situ groups were 88.2 and 70.8%, respectively (x2=2.62; NS). Analysis of results suggests that: 1) the reversed saphenous vein bypass provides excellent results if vein harvest and preparation are as atraumatic as possible; 2) expertise in rendering the valves incompetent markedly increases patency in thein situ technique; 3) during the first 12 months, Doppler follow-up of measured distal pressures is necessary in order to detect pathologic changes of the bypass and adjacent arterial tree.     

应急体外循环的临床应用

目的 探讨应急体外循环（ＥＣＰＢ）在抢救心脏或非心脏危重病人中的意义和作用。方法 心脏病人以动脉－静脉转流法,非心脏病人则采用静脉－－静脉转流法。结果 ＥＣＰＢ占同期体外循环手术３．８５％（３３／８５７）。心脏手术ＥＣＰＢ２７例,成功１９例,死亡８例;非心脏手术６例,均抢救成功。结论 在某些紧急情况下采用ＥＣＰＢ可挽救以往认为无法抢救的重危病人的生命或减少后遗症、并发症。     

Large Perigraft Seroma After Aortoiliac Bypass with an Expanded Polytetrafluoroethylene Graft: Report of a Case

A 63-year-old man who had undergone aortoiliac bypass with an expanded polytetrafluoroethylene (PTFE) graft was referred to our hospital for investigation and treatment of a possible pseudoaneurysm of the abdominal aorta. A tender, pulsatile, and bulging mass, about the size of an adult fist, was palpated around the navel. Enhanced computed tomography (CT) showed a large low-density area around the abdominal aorta and PTFE graft, and aortography showed a patent graft with no anastomotic leakage. Operative inspection revealed that the pulsatile mass was a large perigraft seroma, and we replaced the PTFE graft with a new woven Dacron graft. The patient has been well with no sign of recurrence for 1 year, although close long-term follow-up is mandatory.     

1110例冠状动脉搭桥术的早期结果

目的　回顾性总结１９９６ 年１ 月以来１１１０ 例冠状动脉搭桥术（ＣＡＢＧ） 的近期疗效,介绍冠心病搭桥术的体会和经验。　方法　体外循环下行ＣＡＢＧ１０４８ 例,非体外循环ＣＡＢＧ６０ 例。心肌保护均采用冷血含钾停跳液,体外循环时间１１５ ±３５ 分钟,主动脉阻断时间７２ ±２４ 分钟,单支搭桥１１０ 例,２ 支搭桥１４５ 例,３ 支搭桥４１５ 例（３７－３ ％） ,４ 支搭桥或４ 支以上４３９ 例（３９－５％） 。搭桥材料：左乳内动脉７５１ 例,大隐静脉８７７ 例,桡动脉１０１ 例,全动脉化７２ 例。合并手术：室壁瘤切除１１２ 例,室壁瘤折叠１４ 例,左室成形５ 例,瓣膜手术４８ 例,室间隔穿孔修补术５ 例。　结果　住院死亡９ 例,死亡率０－８１％ 。其余患者痊愈出院,心绞痛基本缓解。术后并发症：低心排１１ 例,主动脉球囊反搏７例,围术期心肌梗塞２ 例,脑部并发症３ 例,二次开胸止血４ 例。　结论　选择好靶血管和充分血管化是冠状动脉搭桥术的关键。另外要重视围术期处理。     

非体外循环冠状动脉旁路移植术40例

目的探讨报告非体外循环冠状动脉旁路移植术(OPCAB)的临床应用价值。方法40例患者均在全麻、常温下经胸骨正中切口行OPCAB术,其中单支病变1例,2支病变5例,3支病变16例,4支病变18例。结果全组无手术死亡,平均搭桥3.1支,术后平均呼吸机辅助时间为(8.0±2.5)h。结论对冠状动脉疾病,OPCAB是一种安全,有效的治疗方法。     

冠状动脉旁路移植术围术期心肌肌钙蛋白I动态变化

目的　观察心肌肌钙蛋白I(cTnI)和CK -MB在冠状动脉旁路移植术 (CABG)围术期变化 ,以判断心肌损伤状况。方法　 19例CABG病人 ,其中 3例同时行左室室壁瘤切除。平均体外循环时间12 1min ,阻断升主动脉 5 6min。灌注冷血停跳液保护心肌 ,平均每例搭桥 3 2支。围术期 2 0个时间点取静脉血标本 ,留血浆测cTnI和CK MB。术前及术后第 7d作标准 12导联心电图 (ECG)。结果　cTnI术前 5例升高者 ,停机后全部升高 ,第 8h达高峰 ,术后第 7d有 7例 (36 8% )仍高于正常 ;CK MB阻断升主动脉前正常 ,停机后升高 ,第 6h达高峰 ,术后第 2d全部恢复正常 ;2例发生围术期心梗 (PMI)者 ,整个围术期cTnI高于无PMI者 ;cTnI阻断升主动脉前已升高者 ,术后升高更显著。结论　cTnI与CK MB在CABG术后变化规律相似 ,但cTnI高于正常的持续时间长于CK MB ,有利于回顾性诊断 ;若阻断升主动脉前cTnI已升高 ,术后水平更高 ;cTnI诊断心肌损伤敏感性高于CK -MB。     

Gastrointestinal motility during cardiopulmonary bypass: a sonomicrometric study

Cardiopulmonary bypass (CPB) is known to impair the integrity of the gastrointestinal tract. However, little is known about the movement behavior of the gastrointestinal tract during CPB. This study was aimed to assess the gastrointestinal motility with sonomicrometry, a distance measurement using ultrasound, in a porcine model of CPB. Twelve pigs weighing 70-112 kg were having a standard hypothermic CPB for 120 min either with the nonpulsatile flow (n = 6) or the pulsatile flow (n = 6). Before CPB, piezoelectric echo crystals were placed either along the longitudinal or the circular axis of the pylorus. Patterns of gut movement and the total sonomicrometric activity (TSA) were recorded at several time intervals during experiments as qualitative and quantitative parameters of gut motility. Results showed that the intact regular rhythmic pattern of gut movement was detected before CPB. This pattern changed little when CPB started, but it disappeared at 60 min when the body temperature lowered down to 32 degrees Celsius. During the same period, the TSA reduced significantly along the longitudinal as well as the circular directions of the pylorus. There was no significant difference between the nonpulsatile and pulsatile groups. Gut blood flow reduced significantly in both groups, but it was not associated with the reduced sonomicrometric activity. In conclusion, gastrointestinal motility during CPB can be measured qualitatively and quantitatively by sonomicrometry in a large animal model. Suppression of gut motility during CPB does not seem to be associated with the mode of perfusion but with the reduced body temperature during the hypothermic phase of CPB.     

700例冠状动脉旁路移植术的临床回顾

作者对阜外医院７００例冠状动脉旁路移植术（ＣＡＢＧ）患者的临床资料和手术结果，按时间分Ａ、Ｂ两组进行对比分析，结果显示合并糖尿病、高血脂症、心功能Ⅲ～Ⅳ级、左主干病变、广泛三支病变等在患者中所占比例近三年有显著的增高（Ｐ＜０．０５）；合并高血压病（４１．３％）、陈旧性心肌梗塞（６５．０％）、有左室室壁瘤（２４．３％）、术后需使用ＩＡＢＰ（９．４％）发生率高，但两组间无显著性差异。心肌保护方法的改进、冠状动脉充分再血管化技术的提高和内乳动脉的广泛采用，使术后早期死亡率（Ｂ组９．６％，Ａ组２．７％）及围术期心梗发生率（Ｂ组９．０％、Ａ组３．２％，Ｐ＜０．００５）明显下降。     

Axillobifemoral bypass and aortic exclusion for vascular septic lesions: A multicenter retrospective study of 98 cases

Ninety-eight patients with aortic infection or aortoenteric fistula were treated by axillobifemoral bypasses and aortic exclusion by 22 surgical teams. Early mortality was 24%. Primary patency at two and five years was 62% and 55%, respectively. Actuarial primary patency at two and five years was 82% and 65%, respectively. The actuarial rate of limb salvage at two and five years was 90% and 82%, respectively. Eight aortic stumps ruptured in less than eight months, postoperatively. Two of these ruptures were treated with success. Infection of the axillobifemoral bypasses was observed in seven cases, six of which were treated successfully. Eight patients had axillary complications, all treated successfully without upper limb sequelae. In eight cases, the axillobifemoral bypass was replaced by a thoracic aortic bypass. Early mortality was higher after emergency operation (30%) than after elective operation (14%). Mortality after cure of primary infection (7%) was lower than after secondary infection (27%). The rate of infection in polytetrafluoroethylene axillobifemoral bypass (3%) was lower than in Dacron axillobifemoral bypass (13%). The rate of occlusion of polytetrafluoroethylene axillobifemoral bypass and Dacron axillobifemoral bypass was identical. The rate of occlusion in ringed reinforced grafts was lower (9%) than in the nonreinforced grafts (22%). The rate of occlusion was significantly higher after ablation of graft for occlusive lesions (38%) than after graft for aneurysms (7.9%) (p<0.01).the French University Association for Research in Surgery, Paris, France: Bernard Andréassian, MD, François Bacourt, MD, Xavier Barral, MD, A. Barret, MD, Jean-Pierre Becquemin, MD, Alain Branchereau, MD, R. Brenot, MD, Jean-Michel Chevalier, MD, M. David, MD, J.P. Dereume, MD, Jean-Michel Fichelle, MD, G. Fievé, MD, C. Gautier, MD, H. Giudicelli, MD, Bernard Habozit, MD, Edouard Kieffer, MD, P. Lagneau, MD, J.L. Magne, MD, Dominique Maiza, MD, H. Mary, MD, Philippe Piquet, MD, J.P. Ribal, MD, J.M. Serisé, MD, C. Stankowiak, MD, J. Testard, MD, J. Watelet, MD.