下肢动脉人工血管旁路术后再闭塞的治疗经验

目的总结治疗下肢动脉人工血管旁路术后再闭塞的治疗经验,探索合理的治疗策略。方法回顾性总结19例下肢动脉人工血管旁路术后再闭塞的病例,分析再闭塞的原因,并根据原因选择再次手术的方式。其中4例行人工血管取栓术,5例行人工血管取栓＋远端吻合口成形术,3例行人工血管取栓＋股深动脉扩大成形术,2例行新的人工血管旁路术,1例行髂外动脉内膜剥脱术,2例行骨髓干细胞移植,2例由于肢体广泛坏死,行1期截肢术。在术后进行规律的随访以明确手术的效果。结果19例患者术后1年中定期随访。除2例截肢外,14例围手术期获得了1期成功,成功率82．4％,3例（17．6％）手术失败,术后1年内死亡2例,病死率10．5％。术后1年随访时,人工血管通畅6例,血管通畅率35．3％,保肢率76．4％（13例）。结论人工血管旁路术后再闭塞的治疗比较棘手,术前有效地评估闭塞原因、选择正确的手术方式和良好的随访计划是保持患者肢体功能和生存质量的重要因素。

The treatment of failed low limb prosthetic graft bypass for the chronic low limb ischemia: a report of 19 cases

Objective To determine the optimal strategies of occluded prosthetic bypass and to assess the risk factors which influence the outcome. Methods From September 2003 to December 2004, 19 cases of failed low limb prosthetic graft were treated in the Peking Union Medical College hospital. All of them underwent operation, and the strategies of operation were determined by the cause assessed preprocedure. Four cases underwent thrombectomy only, 5 cases underwent thrombectomy combined with the distal anastomosoplasty, 3 cases underwent thrombectomy combined with profundaplasty, 2 cases underwent vascular re-construction with new prosthetic graft, 1 case underwent external iliac artery endarterectomy, 2 cases underwent stent cell transplantation, and the last 2 cases underwent amputated since the limbs showed un- salvageable. All the cases got at least 1 year following-up. Results In the 17 vascular reconstruction cases except the 2 cases who underwent amputated, 14 cases (82. 4% ) got firstly successes, according to their limb ischemia symptom got well, but the rest 3 cases ( 17. 6% ) failed. And the mortality is 10. 5% (2 cases). In the 1 year following-up, the prosthetic graft patency was 35. 3% (6 cases) , and the limb salvage was 76. 4% (13 cases) . Conclusion Optimal resolution for prosthetic graft re-occlusion should be based on good judgment of the occlusion cause. Then proper correcting the cause plus right following-up program could be the risk factors of prognosis.