The Use of Greater Saphenous Vein In Situ Graft in Arterial Occlusive Disease of Lower Extremity

하지동맥 폐쇄성 질환에서 자가 대복재정맥 정위 이식편의 이용

  • Shin Yong-Chul (Department of Thoracic & Cardiovascular Surgery, National Medical Center) ;
  • Kim Mi-Jung (Department of Thoracic & Cardiovascular Surgery, National Medical Center) ;
  • Song Chang-Min (Department of Thoracic & Cardiovascular Surgery, National Medical Center) ;
  • Ahn Jae-Bum (Department of Thoracic & Cardiovascular Surgery, National Medical Center) ;
  • Kim In-Sub (Department of Thoracic & Cardiovascular Surgery, National Medical Center) ;
  • Kim Woo-Sik (Department of Thoracic & Cardiovascular Surgery, National Medical Center) ;
  • Kim Byung-Yul (Department of Thoracic & Cardiovascular Surgery, National Medical Center)
  • Published : 2006.06.01

Abstract

Background: Distal anastomosis using artificial vascular graft is difficult when luminal size mismatch occurred owing to severe occlusion of popliteal artery and its branches. So we reconstructed blood flow to ischemic lower limb by using autologous greater saphenous vein in situ graft (GSVISG) as vascular graft material. Material and Method: From July 2000 to July 2005, 26 patients treated using GSVISG. We analyzed clinical results retrospectively by chart review. Result: There was no in hospital or early postoperative death and 6 late deaths occurred during follow up period. Postoperative complications were 5 cases of early graft obstruction, 2 cases of wound dehiscence, 1 case of graft aneurysmal change, 1 case of seroma formation at inguinal wound and 1 case of graft injury during valvulotomy. Overall patency rate during follow up period was 69.3%. Conclusion: Greater saphenous vein in situ graft is acceptable vascular graft for arterial occlusive disease of lower extremity.

배경: 하지동맥의 협착성 질환에서 슬와동맥 및 그 이하 분지들의 협착이 있을 경우 인조혈관과 슬와 동맥 사이의 크기 불일치가 발생하여 원위부 문합이 곤란하게 된다. 본원에서는 자가 대복재정맥 정위 이식편을 이용하여 하지동맥의 혈류를 복원하고자 하였다. 대상 및 방법: 2000년 7월부터 2005년 7월까지 총 26명의 환자에서 대복재정맥 정위 이식편을 이용한 수술을 시행하였으며, 임상 결과들을 환자의 차트 기록에 근거하여 후향적으로 분석하였다. 결과: 술 후 원내 사망이나 조기 사망은 없었으며, 추적기간 동안 총 6명의 만기 사망이 발생하였다. 수술 도중 및 술 후 합병증으로는 5예의 조기 이식편 폐쇄, 2예의 창상 열개, 1예의 이식편 내 동맥류 형성, 1예의 서혜부 창상 장액종 형성, 1예의 이식편 손상이 발생하였으며, 추적기간 동안 이식편 개통률은 69.3%였다. 결론: 대복재정맥 정위 이식편은 슬와동맥 및 그 이하 분지의 협착을 동반한 하지동맥 폐쇄성 질환에서 유용한 혈관 이식편으로 생각된다.

Keywords

References

  1. Kim JM, Cho KS, Park JC, Yoo SY. A clinical analysis of atherosclerosis obliterans in the lower extremities. Korean J Thorac Cardiovasc Surg 1990;23:333-41
  2. Debakey ME, Lawrie GM, Glaesser DN. Patterns of atherosclerosis and their surgical significance. Ann Surg 1985;201: 115-31
  3. Cronenwett JL, Warner KG, Zelenoek GB, et al. Intermittent claudication: current results of nonoperative management. Arch Surg 1984;119:430-6 https://doi.org/10.1001/archsurg.1984.01390160060012
  4. Capek P, Mclean GK, Berkowitz HD. Femoropopliteal angioplasty: factors influencing long-term success. Circulation 1991 ;83:70-80 https://doi.org/10.1161/01.CIR.83.1.70
  5. Leather RP, Shah DM, Corson JD, Karmody AM. Instrumental evolution of the valve incision method of in situ saphenous vein bypass. J Vasc Surg, 1984;1:113-23 https://doi.org/10.1067/mva.1984.avs0010113
  6. Lee HS, Park KY, Kim CH. In situ saphenous vein arterial Bypass: a case report. Korean J Thorac Cardiovasc Surg 1987;20: 187 -90
  7. Hall KV. The greater saphenous vein used in situ as an arterial shunt after extirpation of the vein valves: a preliminary report. Surgery 1962;51:492
  8. Galland RB, Young AE, Jamieson CW. In situ vein bypass: a modified technique. Ann R Coll Sur Engl 1981;63:186
  9. Connolly JE, Kwaan JHM. In situ saphenous vein bypass. Arch Surg 1982;117:1551 https://doi.org/10.1001/archsurg.1982.01380360027006
  10. Thorne J, Danielsson G, Danielsson P, et al. Intraoperative angioscopy may improve the outcome of in situ saphenous vein bypass grafting: a prospective study. J Vasc Surg 2002; 35:759-65 https://doi.org/10.1067/mva.2002.119240
  11. Rosenthal R, Arous EJ, Friedman SG, et al. Endovascularassisted versus conventional in situ saphenous vein bypass grafting: cumulative patency, limb salvage, and cost results in a 39-month multicenter study. J Vasc Surg 2000;31:60-8 https://doi.org/10.1016/S0741-5214(00)70068-1
  12. Lundell A, Nyborg K. Do residual arteriovenous fistulae after in situ saphenous vein bypass grafting influence patency? J Vasc Surg 1999;30:99-105 https://doi.org/10.1016/S0741-5214(99)70181-3
  13. Suggs WD, Sanchez LA, Woo D, Lipsitz EC, Ohki T, Veith FJ. Endoscopically assisted in situ lower extremity bypass graft: a preliminary report of a new minimally invasive technique. J Vasc Surg 2001;34:668-72 https://doi.org/10.1067/mva.2001.115810
  14. Vesti BR, Primozieh J, Bergelin RO, Strandness EJ. Followup of valves in saphenous vein bypass grafts with duplex ultrasonography. J Vasc Surg 2001;33:369-74 https://doi.org/10.1067/mva.2001.111744
  15. Van Damme H, Zhang L, Baguet E, Creemers E, Albert A, Limet R. Crural artery bypass with the autogenous greater saphenous vein. Eur J Vasc Endovasc Surg 2003;26:635-42 https://doi.org/10.1016/S1078-5884(03)00345-9
  16. Dorweiler B, Neufang A, Sehmiedt W, Oelert H.Pedal arterial bypass for limb salvage in patients with diabetes mellitus. Eur J Vasc Endovasc Surg 2002;24:309-13 https://doi.org/10.1053/ejvs.2002.1735
  17. Pomposelli FB, Kansal N, Hamdan AD, et al. A decade of experience with dorsalis pedis artery bypass: analysis of outcome in more than 1,000 cases. J Vasc Surg 2003;37:307-15 https://doi.org/10.1067/mva.2003.125