腹主－股深动脉转流术治疗动脉硬化闭塞症

作者采用腹主－股深动脉旁路转流术治疗主－骼－股动脉硬化闭塞症１４例。术后所有患肢皮温均明显升高，疼痛消失或显著减轻；患肢远端有溃疡者，于术后２～４周全部愈合；３条有中趾坏死者，经截除后创口均愈合。术后６个月，踝／肱指数从０．１±０．１２上升至０．６４±０．２６；足背经皮氧分压从５．２１±２．１４ｋＰａ上升至８．７６±１．３３ｋＰａ．平均随访１５个月，疗效满意。作者认为，对于主－髂－股动脉或骼－股动脉广泛闭塞者，利用股深动脉作为重建血液循环的流出道，是一种有效的手术。     

股深动脉成形术治疗下肢动脉硬化闭塞症

目的：当股浅动脉广泛闭塞时，股深动脉由于其独特的解剖条件和生理功能，为重建下肢血液循环起到重要的作用。本文报道股深动脉成形术治疗下肢动脉硬化闭塞症。方法：5例施行股深动脉成形术。沿股深动脉纵轴切开管壁全层至股总动脉，完成4～5cm长的侧刀形切口，作局部内膜剥脱术，然后取4～5mm宽、长度相匹配的自体大隐静脉补片修复。结果：术后3个月，踝/肱指数从术前0～0.35(0.16±0.17）上升为0.34～0.75（0.66±0.32）。术后随访15～27个月，平均21个月。疗效良好者3例，满意1例，另1例术后6个月继发严重感染而作膝下截肢。结论：在股浅动脉广泛闭塞时，选用股深动脉成形术作为重建患肢血液循环的通道是一种有效的手术方法。手术创伤小，操作方便，更适宜老年患者。     

股深动脉血流重建治疗下肢动脉硬化闭塞症

目的总结股深动脉血流重建治疗下肢动脉硬化闭塞症的经验。方法选择FontaineⅢ、Ⅳ期下肢动脉硬化闭塞症共23例。入选标准：膝上无理想的用于旁路术的流出道，股深动脉主干长度达到或超过股骨干中点且与胭动脉间有侧支血管，近端动脉病变导致股深动脉内无正常动脉血流。采用旁路术、取栓术及股深动脉成形术重建股深动脉血流。结果全部FontaineⅢ期病例于术后肢体静息痛消失；9例FontaineⅣ期病例中术后肢体静息痛消失7例，6例于术后10d行截足（趾）术，1例于术后1周行膝上截肢术。手术后踝／肱血压指数显著增加（P〈0．01）。术后22例随访2个月至6年，移植血管3年通畅率为82％。结论股深动脉血流重建治疗严重肢体缺血简单、安全、有效。     

股深动脉成形术治疗下肢动脉硬化闭塞症

目的：当股浅动脉广泛闭塞时，股深动脉由于其独特的解剖条件和生理功能，为重建下肢血液循环起到重要的作用。本文报道股深动脉成形术治疗下肢动脉硬化闭塞症，方法：5例施行股深动脉成形术。沿股深动脉纵轴切开管壁全层至股总动脉，完成4～5cm长的侧刀形切口，作局部内膜剥脱术，然后取4～5mm宽，长度相匹配的自体大隐静脉补片修复。结果：术后3个月，踝／肱指数从术前0～0．85(016±0．17)上升为0．34～0．75(0．66±0．32)。术后随访15～27个月．平均21个月。疗效良好者3例，满意1例，另1例术后6个月继发严重感染而作膝下截肢。结论：在股浅动脉广泛闭塞时，选用股深动脉成形术作为重建患肢血液循环的通道是一种有效的手术方法。手术创伤小，操作方便，更适宜老年患者。     

腹主—股深动脉转流术治疗动脉硬化闭塞症

作者采用腹主－股深动脉旁路转流术治疗主－髂－股动脉硬化闭塞症１４例。术后所有患肢皮温均明显升高，疼痛消失或显著减轻；患肢远端有溃疡者，于术后２－４周全部愈合，３条有中趾坏死者，经截除后创口均愈合。作者认为，对于主－髂－股动脉或髂－股动脉广泛闭塞者，利用股深动脉作为重建血液循环的流出道，是一种有效的手术。     

应用显微外科技术治疗下肢动脉闭塞症

目的探讨下肢动脉闭塞症的血运重建方法及疗效。方法1998年7月～2005年3月，收治下肢动脉闭塞症29例。男22例，女7例，年龄22～86岁。其中血栓闭塞性脉管炎（thromboangiitis obliterans，TAO）9例，动脉硬化性闭塞症（arterial sclerosis obstruction，ASO）17例，糖尿病足（diabetic foot，DF）3例。左下肢17例，右下肢11例，双下肢1例。测定踝肱指数（ankle—branchial index，ABI）〈0．96例，〈0．523例。29例行彩色超声多普勒检查，其中ASO和DF患者均行MRA检查，提示动脉狭窄或闭塞部位：TAO股浅动脉下段3例，胭动脉5例，跖背动脉1例（双侧）；ASO髂总动脉2例，髂外动脉4例，股动脉10例，胭动脉1例；DF均为股浅动脉。15例行数字减影血管造影检查提示有合适的流出道。根据动脉狭窄或闭塞部位和程度分别对11例患者行一期深组动静脉转流术；16例动脉旁路转流术；1例曾在外院行股总动脉血管旋切成形术者，作截肢处理；1例曾在外院行血管支架植入及人造血管移植术者，行动脉旁路转流术。结果术后TAO患者坏死组织去除后2例创面Ⅰ期愈合，4例经换药后愈合，3例表浅坏死，坏死组织脱落后生长出正常组织；As0患者中14例创面Ⅰ期愈合，2例经换药愈合，1例曾在外院行血管支架植入及人造血管移植术者，术后血管闭塞，作截肢处理；DF患者中2例坏死组织去除后经换药愈合，1例术后症状加重，第2足趾进一步坏死后截肢。29例患者均获随访3个月～7年。术后疗效评价：治愈12例，明显改善10例，改善4例，无变化3例。ABI恢复正常12例，〈0．914例，〈0．53例。结论一期深组动静脉转流术和动脉旁路转流术是治疗下肢动脉闭塞症的有效方法，应用显微外科技术吻合血管可提高血管通畅率。     

下肢动脉搭桥术后移植物闭塞的外科治疗体会

目的探讨下肢动脉搭桥术后再缺血的治疗策略。方法选择2002年7月～2006年2月我院收治下肢动脉搭桥术后移植物闭塞患者21例，男17例，女4例，平均68．2岁；21例患者共行手术35例次：再次下肢动脉搭桥术16例次（45．7％），单纯人工血管取栓手术10例次（28．6％），人工血管取栓同时行股或胭动脉内膜剥脱术6例次（17．1％），3例患者行截肢术（8．6％）。结果35例次手术探查发现移植物闭塞原因以远侧流出道病变（62．9％）和远侧吻合口内膜增生（25．7％）为主。其中13例次术后再次闭塞行手术治疗，但人工血管搭桥术平均再发闭塞时间明显长于其他术式。2例患者围手术期死亡。17例患者末次行血运重建手术，术后随访6—44个月，平均17个月，未见缺血症状复发。结论下肢动脉搭桥术后移植物闭塞原因以远侧流出道病变为主，再次搭桥手术可作为首选术式，术后缺血反复发作导致截肢。     

下肢动脉硬化性闭塞症的外科治疗

自１９８８年１月至１９９２年１２月，我们共收治下肢动脉硬化性闭塞症２７例，涉及３８条肢体。男性２５例，女性２例，年龄４７～７２岁。动脉闭塞的部位以髂总、髂外动脉到股浅动脉这一段最多，占６８．％；其次为腹主动脉到双髂动脉，占２６．３％。全部病例均作了动脉旁路移植术；腹主－髂或股动脉、髂册和股－动脉等方式。手术治疗总有效率８６．８％；其中显效７６．３％。无效和恶化者１３．２％，多因远侧动脉有广泛狭窄和闭塞所致；这类病人不宜作动脉旁路移植术。在股总或股浅动脉闭塞时，应尽量利用股深动脉，作股深动脉成形术或腹主动脉＋股深动脉人工血管搭桥术。作股－动脉搭桥时，常用大隐静脉，需注意其厚度能否耐受动脉高压，以免以后破裂引起大出血。     

股-股深动脉转流术治疗动脉硬化闭塞症

我院自１９９５年７月至１９９７年９月采用股股深动脉转流术治疗５例髂总动脉股浅动脉硬化闭塞症，报道如下。１．临床资料：５例均为男性，年龄６２～７３岁，平均６６７岁；右下肢３例，左下肢２例。均扪不到股动脉搏动，并有患肢肌肉萎缩，皮肤纤薄，患足苍白或...     

下肢多节段动脉硬化闭塞症的联合治疗

目的探讨下肢多节段动脉硬化闭塞症治疗方法及临床疗效。方法2004年3月至2005年11月,采用髂动脉球囊扩张和支架植入结合动脉旁路术、股深动脉成形术或自体骨髓干细胞移植术治疗下肢多节段动脉硬化闭塞症17例(19条肢体),术前踝肱指数(ABI)为(0.26±0.13),术前常规行血管彩超及CTA检查评价下肢动脉病变情况。结果髂动脉球囊扩张和支架植入19条,股深动脉成形11条,股-动脉人工血管转流术12条,自体骨髓干细胞移植3条,均获得成功。均未出现严重并发症。术后ABI(0.64±0.17)(P<0.05,t检验),随访期间,4例残余间歇性跛行,3例术后3个月行干细胞移植术后症状明显好转。结论多方法联合是治疗多节段多平面下肢动脉硬化闭塞症的有效方法;股深动脉的病变范围与手术治疗效果密切相关;术前正确评价股深动脉的通畅程度十分重要。     

When can revascularization be limited to the profunda femoris alone?

Dealing with lower limbs arteriopathies with combined aorto iliac and superficial femoral occlusive diease and when ischemia leads to operation should an extension bypass to the popliteal or tibial artery be associated every time it is possible? The authors have investigated the results of revascularizing operation above the profunda femoris on 35 limbs (27 patients). On 19 limbs only, has the revascularization been sufficient to cure the distal ischemia. On the other 16 limbs, a second operation was necessary 7 times an extension bypass to the popliteal or tibial artery, once an above knee amputation, twic a below knee amputation. From the comparison of these results with the degree of ischemia and the arteriographic aspect of the profunda femoris, the author's conclusion is that revascularization must extent below the profunda femoris unless the profunda is in good condition and there is no rest ischemia.     

Iatrogenic femoral artery aneurysms in orthopaedic practice

BACKGROUND: Iatrogenic injury to the femoral vessel is a rare complication after fracture of hip. Pseudoaneurysm formation of superficial femoral artery or profunda femoris artery is detected quite late. We present our experience for surgical management of pseudoaneurysm of femoral artery after iatrogenic trauma during management of fracture of femur. METHODS: A retrospective analysis was carried out for eight patients with femoral artery pseudoaneurysm treated surgically during the last 10 years in one surgical unit. RESULTS: Of eight patients with pseudoaneurysm of femoral artery, six had superficial femoral artery aneurysm and two profunda femoris artery aneurysm. Mean duration for presentation was 4 months (range 2-6 months). Methods of surgical intervention were direct closure of arterial defect after aneurysmectomy in six cases and use of saphenous vein patch graft for repair of artery in two cases. Mean size of aneurysm was 12 x 7 cm (range 8 x 4 cm to 20 x 12 cm). All patients were doing well during a mean follow up of 72 months (range 6-110 months). CONCLUSION: Large pseudoaneurysms of femoral arteries after iatrogenic injury during management of fractures of femur should be managed by aneurysmectomy and arterial repair with or without saphenous vein patch graft.     

Idiopathic arterial calcification in 9-year-old boy: a successful reconstruction for ilio-femoral occlusion

We treated a 9-year-old boy suffering from underdevelopment of the length as well as circumference of the left lower extremity due to idiopathic arterial calcification of the left ilio-femoral artery. There was no deposition of calcium on the other arteries and tissues of the body. He had undergone aorto-internal iliac bypass graft with resection of the calcific iliac and superficial femoral arteries in the National Fukuoka Central Hospital when he was 4 years old, but the graft became occluded. He was admitted to the University of the Ryukyus Hospital. The common femoral artery was completely occluded with severe deposition of calcium on the wall and with gritty contents. The profunda femoris artery and the proximal part of the superficial femoral artery were also completely occluded with organized thrombi. Re-establishment of blood flow to the ischemic left lower extremity was performed with an ilio-femoral cross-over synthetic bypass and femoro-popliteal saphenous vein bypass graft, in situ. The patient has been well with adequate pulses of the pedal and posterior tibial artery 8 months after surgery.     

Idiopathic arterial calcification in 9-year-old boy: a successful reconstruction for ilio-femoral occlusion

We treated a 9-year-old boy suffering from underdevelopment of the length as well as circumference of the left lower extremity due to idiopathic arterial calcification of the left ilio-femoral artery. There was no deposition of calcium on the other arteries and tissues of the body. He had undergone aorto-internal iliac bypass graft with resection of the calcific iliac and superficial femoral arteries in the National Fukuoka Central Hospital when he was 4 years old, but the graft became occluded. He was admitted to the University of the Ryukyus Hospital. The common femoral artery was completely occluded with severe deposition of calcium on the wall and with gritty contents. The profunda femoris artery and the proximal part of the superficial femoral artery were also completely occluded with organized thrombi. Re-establishment of blood flow to the ischemic left lower extremity was performed with an ilio-femoral cross-over synthetic bypass and femoro-popliteal saphenous vein bypass graft,in situ. The patient has been well with adequate pulses of the pedal and posterior tibial artery 8 months after surgery.     

Crossover ilioprofunda reconstruction: an expanded role for obturator foramen bypass.

The standard obturator foramen bypass extends from the aorta or iliac artery to the ipsilateral superficial femoral or popliteal artery. This operation has been both effective and versatile as an indirect bypass procedure for circumventing difficult vascular problems in the femoral triangle. A case is presented of a patient whose limb was salvaged by an obturator foramen bypass from the contralateral iliac artery to the profunda femoris artery. This unique case is compared to other published cases to emphasize the potential advantages of the profunda femoris as the preferred graft outflow in selected cases of arterial reconstruction through the obturator foramen.     

Angioplasty or bypass for superficial femoral artery disease? A randomised controlled trial.

AIM: To evaluate whether angioplasty or above-knee bypass is the best treatment for symptomatic superficial femoral artery occlusive lesions, we performed a multicentre randomised trial. PATIENTS AND METHODS: Between October 1995 and August 1998, 56 patients were enrolled, all with symptoms related to a 5-15 cm long occlusive lesion of the superficial femoral artery. Thirty-one patients were randomly assigned to percutaneous transluminal angioplasty (PTA); 25 patients to bypass surgery. All patients were followed at 1, 6 and 12 months after the procedure. The primary outcome of our study was re-occlusion of the femoral artery. RESULTS: Thirty patients underwent the allocated PTA and 24 patients underwent bypass surgery. Cumulative 1-year primary patency after PTA was 43 and 82% after bypass surgery. After PTA more than half of the patients had a re-occlusion with an absolute risk reduction of 31% (CI: 6-56%) in favour of bypass surgery. The hazard ratio for occlusion comparing PTA with bypass surgery is 2.24 (95% CI: 0.9-5.58). CONCLUSION: Despite 18 participating centres only 56 patients were randomised to PTA our bypass surgery. Based on our results, for every three patients treated with bypass surgery instead of PTA, one additional re-occlusion is prevented. Therefore, we conclude that with respect to patency, for long superficial femoral artery (SFA) stenoses or occlusions, surgery is better than PTA.     

个体化血管重建术治疗下肢多平面动脉硬化闭塞症

目的 观察序贯立交搭桥或结合腔内技术治疗下肢多平面动脉硬化闭塞症的临床效果。方法 2004年4月～2005年7月，对11例14条下肢多平面动脉硬化闭塞症患者，采用序贯立交搭桥或动脉内膜剥脱术或腔内外结合手术治疗。其中男10例，女1例；年龄62～79岁，平均70．5岁。表现为间歇性跛行8例（FontaineⅡ期），静息痛3例（Fontaine Ⅲ期），足趾溃疡、坏疽1例（FontaineⅣ期）。彩色多普勒检查示14条下肢均为多平面动脉硬化闭塞，踝肱指数（ankle brachialindex，ABI）为0．36±0．11。下肢数字减影血管造影（digital subtraction angiography，DSA）显示双侧髂总动脉闭塞2em、髂外动脉闭塞、双侧股浅动脉闭塞3例，右侧髂总动脉狭窄、髂外动脉闭塞、双侧股浅动脉闭塞1例，单侧髂外动脉狭窄、股浅动脉闭塞7例。术后行DSA、彩色多普勒检查及ABI测定，观察血管通畅情况。结果 术后无死亡。患者均获随访3～26个月，平均14．5个月。间歇性跛行、静息痛等症状均消失，ABI术后为0．89±0．13，与术前比较差异有统计学意义（P〈0．01）。肢体获救率100％。术后3～280d行下肢DSA显示转流血管通畅率为92．86％（13／14）。结论 序贯立交搭桥或腔内外手术结合，是治疗严重下肢多平面动脉硬化闭塞症的一种可靠、安全、相对微创的治疗方法。     

Transobturator aorto-profunda femoral artery bypass using the direct medial thigh approach

We present a novel technique for aorto-profunda femoral artery bypass using both the obturator foramen and the direct medial thigh approach to the profunda femoral artery in a patient with an infected femoral graft and limb-threatening ischemia. This patient has undergone multiple bypass grafts to salvage function of his lower extremities, but these standard anatomic and extra-anatomic bypasses had failed because of graft infections. The technique as well as the surgical anatomy are described. The combination of the transobturator aorto-profunda femoral artery bypass and the direct medial approach to the profunda femoral artery is technically feasible, provides adequate outflow for limb salvage in selected patients with good collateral arteries, offers acceptable long-term patency, and is particularly useful when the groin is hostile to dissection or graft material and the superficial femoral and popliteal arteries are occluded.     

The profunda femoris: a durable outflow vessel in aortofemoral surgery.

Aorta-common femoral artery bypass is the standard operation for relief of aortoiliac occlusive disease. When extensive superficial femoral artery disease coexists, the profunda femoris, even in its distal portion, may be used as the outflow vessel. To test this assumption we compared cumulative patency, limb salvage, and the need for distal bypass of 134 aorta-profunda femoris and 151 aorta-common femoral artery bypasses performed consecutively for aortoiliac occlusive disease over a 12-year period. We also analyzed results of proximal (n = 103) and distal (n = 31) aortoprofunda bypasses. Angiographic and noninvasive studies showed greater disease in limbs undergoing aorta-profunda femoris bypass. However, no difference was observed in cumulative patency (91% +/- 6% vs 96% +/- 3%) or limb salvage (90% +/- 6% vs 94% +/- 3%) at 5 years. Seventeen distal bypasses in the group undergoing profunda femoris bypass and 20 distal bypasses in the group undergoing common femoral artery bypass were required to maintain limb salvage. Proximal and distal aorta-profunda femoris bypasses showed no difference in cumulative patency (91% +/- 9% vs 95% +/- 6%) or limb salvage (94% in each group) at 3 years. Standard aorta-common femoral artery and aorta-profunda femoris bypass provide cumulative patency and limb salvage exceeding 90% at 5 years; concomitant or subsequent distal bypass was required in 12% or limbs undergoing aorta-profunda femoris bypasses. Both proximal and distal profunda femoris arteries provide a durable outflow tract when aortoiliac and femoropopliteal occlusive disease are combined.     

下肢慢性缺血合并急性血栓形成的外科治疗

目的 探讨治疗下肢慢性缺血合并急性血栓形成的最佳外科治疗手段.方法 回顾性分析2000年1月～2010年10月我科收治的26例下肢慢性缺血合并急性血栓形成患者的临床资料,比较单纯采用股动脉切开导管取栓术组(10例)与股-腘动脉切开取栓联合动脉重建手术组(16例)的疗效.结果随访时间1～114个月,单纯股动脉切开术组中的...