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Der Vena-saphena-magna-Bypass

The saphenous vein bypass for arterial reconstruction

  • Themenschwerpunkt: Techniken des Autologen Venenbypasses
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Grundlagen

Anhand einer retrospektiven Analyse eigener Ergebnisse soll der Stand der chirurgischen Technik diskutiert werden. Grundlage für die Diskussion sind die am Workshop “Der Venenbypass” 1991 in Linz gehaltenen Referate.

Methodik

Zwischen 1970 und 1991 wurden an der I. Chirurgischen Universitätsklinik Wien 590 reversierte Venenbypässe angelegt. Anschlußgefäß war in 39% die supragenuale, in 31% die infragenuale A. poplitea, in 30% ein krurales Gefäß.

Ergebnisse

Die 30-Tage-Letalität betrug 2%, die mediane Nachbeobachtungszeit 65 Monate. Die Gesamtfunktionsrate nach 60 Monaten betrug 55%, die sekundäre Funktionsrate 70% für alle Patienten. Die primäre Funktionsrate für supragenuale Venenbypässe betrug 61%, für infragenuale 49% und für krurale 52%. Der Beinerhalt nach 60 Monaten war in 88% gewährleistet.

Schlußfolgerungen

Ein Literaturüberblick diskutiert die verschiedenen Trends auf dem Gebiet der Venenbypasschirurgie zur Revaskularisation der unteren Extremität. Große prospektive, randomisierte Studien werden benötigt, um die beste Technik für distale Rekonstruktionen der unteren Extremität zu evaluieren, daher muß die Wahl des Vorgehens derzeit der Präferenz des Chirurgen überlasen werden.

Summary

Background

During a 20-year period between 1970 and 1991 590 reversed vein bypass grafts were performed for claudication (40%) and for limb salvage (60%).

Methods

Outflow anastomoses were constructed to the suprageniculate popliteal (39%), infrageniculate popliteal (31%) and crural arteries; the technique was reversed vein bypass graft.

Results

The 30-day mortality rate was 2%, the median fllow-up 65 months. At 60 months primary graft patency was 55% overall; secondary graft patency was 70%, respectively. Primary cumulative patency rates at 60 months depending on the outflow site were as follows: suprageniculate popliteal 61%, infrageniculate popliteal 49% and crural 52%. Cumulative limb salvage at 60 months was 88% overall. A literature review on current trends in lower limb vein bypass surgery is given.

Conclusions

A 5-year graft patency rate of 55% and a limb salvage rate of 88% were achievable with the reversed vein bypass. Literature shows, that the performance of the reversed vein graft and the in situ technique yield similar results. Further prospective randomized studies are needed to find out the superior technique for lower limb revascularization.

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Authors and Affiliations

  1. Klinischen Abteilung für Gefäßchirurgie der Universitätsklinik für Chirurgie, Währinger Gürtel 18-20, A-1090, Wien

    M. Prager, I. Huk, G. Kretschmer &  P. Polterauer

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  1. M. Prager
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  2. I. Huk
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  3. G. Kretschmer
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  4. P. Polterauer
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Prager, M., Huk, I., Kretschmer, G. et al. Der Vena-saphena-magna-Bypass. Acta Chir Austriaca 25, 294–297 (1993). https://doi.org/10.1007/BF02602201

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  • DOI: https://doi.org/10.1007/BF02602201

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