膝下动脉球囊血管成形术治疗重症下肢缺血的临床研究

目的 评价膝下动脉闭塞首选球囊血管成形术的临床治疗效果.方法 2005年12月至2009年5月,对于连续收治且符合手术指征的54例(61条肢体)膝下动脉重度狭窄或闭塞的重症下肢缺血患者,采用膝下动脉球囊血管成形术进行治疗.其中男性37例,女性17例,平均年龄66岁.术前踝肱指数平均0.43±0.27.根据病变部位选择手术方法,膝下动脉病变首选球囊血管成形术,合并髂股动脉病变同时进行血管重建(支架置入或动脉旁路术).结果 髂股动脉重建(28条肢体行支架置入,5条肢体行动脉旁路术)均一期成功.膝下动脉球囊血管成形术57条肢体获得一期成功,技术成功率93.4%.围手术期主要并发症为小腿血肿3例(4.9%),膝下截肢2例(3.3%).术后踝肱指数增加至0.86±0.21,与术前相比差异有统计学意义(P<0.01).本组平均随访时间(16±11)个月,一期通畅率61.1%,21条肢体发生再狭窄(38.9%),其中10条肢体再次接受外科干预,二期通畅率75.9%.截肢3条肢体,总的救肢率91.8%.结论 球囊血管成形术是治疗重症下肢缺血安全有效的方法,可以作为膝下动脉病变首选的外科干预手段.     

解剖外腋-股、股-股动脉旁路移植术治疗主髂动脉闭塞症

目的探讨解剖外腋股、股股动脉旁路移植术治疗主髂动脉闭塞症的疗效。方法采用解剖外旁路移植术治疗主髂动脉闭塞症患者３２例。１８例腹主动脉或两侧髂动脉闭塞者采用腋股动脉旁路术，其中２例为腋两股动脉旁路术；１４例单侧髂动脉闭塞者采用股对侧股动脉旁路术。采用腋股动脉旁路的患者，术中８例用真丝人造血管移植，１０例用聚四氟乙烯（ＧｏｒｅＴｅｘ）人造血管；股股动脉旁路术中６例用真丝人造血管移植，１例用自体大隐静脉，７例用ＧｏｒｅＴｅｘ人造血管。结果术后５年随访时，股股动脉旁路术通畅率为７８％，其中真丝人造血管与ＧｏｒｅＴｅｘ人造血管通畅率无明显差异；腋股动脉旁路术中，８例真丝人造血管均已闭塞，１０例ＧｏｒｅＴｅｘ人造血管中１例闭塞，１例发生腹股沟部假性动脉瘤。结论解剖外动脉旁路移植术操作简单，创伤小，无腹部手术并发症，手术安全，术后恢复快。真丝人造血管的使用应限于短段的股股动脉旁路术     

剖解外腋—股,股—股动脉旁路移植术治疗主髂动脉闭塞症

目的 探讨剖解外腋－股、股－股动脉旁路移植术治疗主髂动脉闭塞症的疗效。方法 采用解剖外旁路移植术治疗主骼动脉闭塞症患者３２例。１８例腹主动脉或两侧髂动脉闭塞者采用腋－股动脉旁路术,其中２例为腋－两股动脉旁路术;１４例单侧髂动脉闭塞者采用股－对侧股动脉旁路术。采用腋－肌动脉旁路的患者,术中８例用真丝人造血管移植,１０例四氟乙烯（Ｇｏｒｅ－Ｔｅｘ）人造血管;股－股动脉旁路术中６例用真丝人造血管移植,１     

股腘动脉闭塞症的手术治疗

目的 探讨股腘动脉旁路移植术治疗下肢动脉硬化闭塞症(C、D级病变)的近中期疗效.方法 2005年1月至2009年2月,170例患者(191条肢体)行股动脉以远血管重建术.其中男性108例,女性62例;年龄45～85岁,平均67岁.症状包括间歇性跛行78例,静息痛62例,下肢缺血性溃疡19例,远端组织坏死11例.所有患者术前均行动脉造影检查,根据TASC Ⅱ分级:C级病变127条肢体,D级病变64条肢体.手术方法包括大隐静脉原位旁路移植术15条肢体,大隐静脉转位20条肢体,人工血管旁路移植术128条肢体,大隐静脉与人工血管组合旁路移植术28条肢体.结果 围手术期无死亡病例.术后随访6～36个月,平均(24±6)个月;76例失访,随访率57%(109/191).一期通畅率84.4%(92/109),其中人工血管旁路移植通畅率88.2%(75/85),大隐静脉(原位、转位、组合)旁路移植通畅率70.8%(17/24).二期通畅率89.9%(98/109).结论 人工血管旁路移植术是治疗严重股腘动脉闭塞症(TASC C和D级病变)的主要方法,手术疗效满意.     

腋-股动脉旁路移植救治慢性重症下肢缺血

目的 探讨腋-股动脉转流救治慢性重症下肢缺血的疗效。方法 回顾性分析1995年1月至2002年11月的63例主髂动脉闭塞患者行腋-单股和腋-双股动脉人工血管旁路移植的临床资料。结果 44例出院时静息痛消失，19例患者间歇跛行消失，平均踝/肱比从术前的0、18(0-0．49)提高到0．68(0．29～1．04)。本组肢体救治率87．4％，截肢率7．9％。3例死亡，手术死亡率是4．7％。1、3、5年通畅率分别为93．2％、79．8％、64．1％。结论 因主髂动脉闭塞导致慢性重症下肢缺血的高危患者，通过腋-股动脉人工血管旁路移植可有效的挽救肢体和生命。     

术中髂动脉支架结合股动脉旁路术治疗多节段动脉硬化闭塞症

目的 探讨术中髂动脉腔内成形及支架植入结合股-Guo动脉旁路术治疗多节段动脉硬化闭塞症的初步临床经验。方法 采用术中同时行髂动脉腔内成形和支架植入结合股-Guo动脉旁路术治疗多节段动脉硬化闭塞症10例（12条肢体）。结果 术中11条髂动脉行腔内成形和支架植入均获成功,9条肢体行股-Guo动脉人工血管旁路术,3条肢体行股-股-Guo动脉人工血管旁路系列转流术;1条肢体股-Guo动脉旁路术失败,本组患者无重要脏器并发症和手术死亡。平均随访时间6个月（1-12个月,髂动脉腔内支架通畅率100%;3条股-股动脉耻骨上人工血管转流均通畅;而股-Guo动脉人工血管通畅率83.3%;截肢率8.3%。结论 术中髂动脉腔内支架结合股-Guo动脉旁路术是治疗多节段动脉硬化闭塞症的安全、有效方法。     

微创技术结合外科手术治疗重症下肢缺血

目的 探讨术中血管微创治疗技术结合外科手术治疗重症下肢缺血的初步临床经验。方法 1999年7月至2000年10月,采用术中同时行髂动脉腔内微创治疗技术(球囊扩张和支架植入)结合肢体远端动脉重建术治疗广泛多节段动脉硬化闭塞症15例(20条肢体)。结果 术中17条髂动脉微创介入治疗均获成功,11条肢体同时行股-腘动脉人工血管旁路术,3条肢体行股-股-腘动脉人工血管旁路系列转流术,5条肢体行股深动脉成形术。其中有1条肢体股-腘动脉旁路术失败。本组患者无重要脏器并发症和手术死亡。平均随访时间8个月(1-16个月),髂动脉腔内支架通畅率100％,3条股-股动脉耻骨上人工血管转流均通畅,而股-腘动脉人工血管通畅率78．6％,截肢率10．0％。结论 术中髂动脉腔内微创介入治疗技术同时结合远端动脉重建术是治疗广泛多节段动脉硬化闭塞症的害全右特肯沸．     

解剖外旁路手术在下肢缺血性病变治疗中的应用

解剖外旁路手术(extra anatomicbypass)是指经非自然血管途径的旁路手术,主要指腋股旁路手术,股股旁路手术,及颈动脉锁骨下动脉旁路手术、腋腋旁路手术、脾肾动脉旁路手术等。1　腋股动脉旁路手术腋股动脉旁路手术又可分为腋单股动脉旁路手术(ax illounifemoral,AxUF)及腋双股动脉旁路手术(axillob ifemoral,AxBF)。Blaisdele(196 3)首先报道腋股动脉旁路移植手术的临床应用。最初该术式主要用于解决下肢严重缺血病变。后来逐渐用于腹主动脉人工血管感染,主髂动脉闭塞性病变。其主要适应证是:患有腹主动脉末端及两则髂动脉闭塞(Leriche…     

血运重建治疗下肢动脉缺血的临床分析

目的 总结对严重下肢动脉缺血患者重建患肢血供的临床效果。方法 对1995年1月－2000年12月间重建肢体血液循环的49例56侧肢体进行回顾性分析,动脉闭塞分别位于近肾腹主动脉－双髂动脉,腹主动脉－双髂动脉,髂动脉,股动脉或股－Guo动脉。手术指征是间歇性跛行,静息痛和趾端坏疽。手术方式是股动静脉转流术12例14侧肢体,人造血管旁路搭桥术28例33侧肢体,动脉内膜切除及股深动脉补片成形术5例5侧肢体,一期截肢4例。结果 术后随访平均38个月。在重建血运的52侧肢体中,4侧出现患肢坏疽而截肢;共截肢8侧,累计截肢率为14.3％,人造血管旁路搭桥术、动脉内膜切除及股深动脉补片成形状的肢体血流经为68.4%(26/38侧肢体),保肢率为94.7%(36/38侧肢体);股动静充术的保率为85.7%(12/14侧肢体)。结论 血运重建是救治下肢动脉闭塞患肢的有效方法,应根据具体情况选择动脉旁路搭桥、动脉内膜切除及股深动脉补片成形或股动静脉转流术。动脉造影是重建手术成功的必要保证。     

远端流出道不良致严重下肢缺血39例的旁路移植术分析

目的探讨严重下肢缺血动脉的旁路移植手术方法 ,以挽救肢体避免截肢或降低截肢平面。方法 39例共 4 5条下肢仅有小腿单支流出道动脉的患者接受了动脉旁路移植手术。主要方式为股动脉 动脉人工血管 小腿动脉自体血管旁路移植术 2 1条 (4 6 7% )和动脉 小腿动脉旁路移植 10条 (2 2 2 % )。结果 39例患者中 ,1例术后第 5天因呼吸功能衰竭死亡 ,围手术期死亡率为 2 6 % ;围手术期移植血管闭塞 1例 (2 6 % ) ,手术成功率 97 4 %。出院时血管通畅率 10 0 % ,足部创面的愈合率 30 %。结论采用下肢远端动脉旁路移植治疗由仅有小腿单支流出道动脉供血的严重下肢缺血 ,可以挽救肢体或降低截肢平面 ,还可以为足部创面的愈合提供较好的营养环境。     

An optimal inflow procedure for multi-segmental occlusive arterial disease: ilio-femoral versus aorto-bifemoral bypass

Treatment of chronic critical limb ischemia still remains one of the most serious problems of vascular surgery. Most often, chronic critical limb ischemia is caused by multi-segmental disease of arterial tree, involving both the aorto-femoral and infrainguinal vessels. In the majority of these cases, proper correction of aorto-iliac arteries is sufficient to restore the circulation in lower limbs. However, in 10–15% it is necessary to perform multi-segmental reconstructions. In these cases it is extremely important to choose the optimal inflow procedure. The aim of this retrospective study was to compare perioperative and long-term results of multi-segmental reconstructions, using aorto-bifemoral, unilateral ilio-femoral, and extra-anatomical bypass as inflow procedures. During the 10-year period (1984–1994), 4074 aorto-femoral reconstructions were performed for treatment of occlusive arterial disease. In 449 cases (11%), multi-segmental aorto-femoro-poplteal/tibial reconstructions were undertaken. Aorto-bifemoral bypasses was performed in 131, unilateral ilio-femoral bypasses in 288, and extra-anatomical bypasses in 30 cases. In 221 cases, the operations were performed in one stage, and in 228 cases a two-stage procedure took place. Postoperative mortality was 3.8% in the aorto-bifemoral bypass group, 1.3% in the unilateral ilio-femoral group, and 3,3% in the extra-anatomical group. Primary inflow graft patency rate after 12 months was 94.7% in the aorto-bifemoral bypass group, 94.1% in the unilateral ilio-femoral group, and 80% in the extra-anatomical group. Secondary inflow graft patency rate was 97.8% in the aorto-bifemoral bypass group, 96.2% in unilateral ilio-femoral group, and 96.7% in extra-anatomical group. The 5-year primary and secondary graft patency rates were 90.9% and 94.7% in the aorto-bifemoral bypass group, 88.5% and 93.4% in the unilateral ilio-femoral group, and 66.7% and 77.3% in the extra-anatomical group, respectively. Conclusion: Unilateral ilio-femoral bypass as an inflow procedure for treatment of multilevel occlusive arterial disease is as effective as aorto-bifemoral bypass, with lower perioperative mortality and morbidity rates. Extra-anatomical bypasses are, however, less effective.     

Long-term results of reconstructive surgery for aorto-iliac arterial occlusive lesions

We report a review of 215 reconstructions for aorto-iliac arterial occlusive lesions, involving 156 patients. At 13 years, the cumulative patency rate of 158 aorto-femoral or aorto-iliac dacron synthetic bypass prostheses was 71.6 per cent as compared to 52.7 per cent at 5 years for 22 blunt endarterectomies and 47.4 per cent at 6 years for 35 axillo-femoral bypass prostheses. Of the 158 synthetic bypass prostheses, the cumulative patency rate at 13 years was 85.1 per cent in cases with no occlusive involvement of the peripheral arteries, significantly higher (p<0.03) than the 39.3 per cent patency rate at 7 years in cases in which associated femoro-politeal occlusive lesions were not treated. At 12 years, the patency rate was 53.2 per cent in cases in which associated femoro-popliteal occlusive lesions were treated during the same reconstructive intervention, i.e. markedly higher (p<0.08) than in patients in whom the degree of outflow in the distal vessels was poor. Our findings indicated that, in order to achieve a satisfactory long-term patency rate, it is important to treat associated occulusive lesions in the femoro-popliteal arteries.     

Long-term outcome in patients under 40 years after revascularization for chronic lower limb ischaemia.

BACKGROUND: In order to find out if surgical or endoluminal treatment changes the long-term results of atherosclerotic occlusive disease in patients of under 40 years of age we reviewed 17 consecutive patients. METHODS: Their mean age was 36.5. Patients with Buerger's disease or inflammatory arteriopathy were excluded. All patients were extremely heavy smokers. The indications for surgical procedures were disabling claudication (less than 100 meters) for 11 patients, rest pain for 4 patients and grangrene of a lower limb for 2 patients. The lesions were aorto-iliac in 12 cases and femoro-popliteal in 5. Ten surgical procedures were performed (5 aorto-femoral bypasses, 1 ilio-femoral bypass associated with an aorto-renal bypass, 2 femoropopliteal bypasses, 1 aorto-iliac endarteriectomy, 1 femoral endarteriectomy). On the other hand there were 7 endoluminal procedures (1 aortic, 4 iliac, 1 femoral and 1 popliteal). RESULTS: The mean follow-up was 97.3+/-50 months (range, from 34 to 216 months). Two patients died by 57 and 132 months respectively. At 5 years the survival rate was 94%; the primary patency rate was 59%; the secondary patency rate was 81% and the limb salvage rate was 94%. At 10 years these rates were respectively 94%, 44%, 54% and 75%. A total of 21 reoperations were performed. During follow-up 11 patients were better, 2 were stable and 4 were worse with 2 limbs lost. CONCLUSIONS: These bad results suggest keeping the surgical and endoluminal indications for patients younger than 40 years with threatened limbs.     

腋-股架桥术治疗髂、股动脉闭塞性疾病

目的：总结腋—股架桥术治疗髂、股动脉闭塞或狭窄的疗效。方法：回顾性分析20例髂、股动脉闭塞或狭窄病例的临床资料、危险因素、手术指征及效果。结果：均行腋—股动脉架桥术，17例单侧，3例双侧，共26条；18例是为拯救肢体而手术，其1，3，5年通畅率为87％(20/23)，74％(17／23)及61％(14／23)。30d内死亡1例(占5％)。3例移植物在术后6．5个月内闭塞，均发生在股—股搭桥中，而腋—股搭桥则长期通畅。结论：对广泛的慢性髂、股动脉闭塞性疾病，腋—股架桥对于行主动脉重建有危险或预期寿命受限的病人不失为一种可行术式。     

下肢动脉硬化闭塞症的外科治疗

目的:探讨外科治疗下肢动脉硬化闭塞症的临床经验。方法:从1995年7月～2002年7月共对292例(313条肢体)动脉硬化闭塞症病人进行外科治疗,其中20条患肢施行解剖外血管重建术,38条患肢施行了腔内外科治疗或合并开放性血管重建手术,255条患肢施行了开放性手术重建下肢血供。结果:手术成功者患肢的踝肱指数与术前比较显著增加(P<0.01),症状得到明显改善。平均随访时间3.1年(0.5～7年),解剖外重建组移植血管一期通畅率为56%,腔内外科组通畅率为78%,开放性手术组通畅率为72%。结论:病人的全身情况、动脉病变的范围和程度是选择下肢动脉硬化闭塞症外科治疗方法的主要依据,为取得较好的长期通畅率和临床效果需要重视围手术期处理和术后随访。     

腘动脉闭塞的手术治疗经验

目的 探讨单纯腘动脉闭塞的外科治疗的策略及效果.方法 回顾性分析2007年6月至2008年6月25例单纯腘动脉闭塞患者手术治疗的临床资料.男性18例,女性7例;年龄17～83岁,平均(53±21)岁.急性缺血11例11条肢体(42.3%),慢性缺血14例15条肢体(57.7%).手术方式包括腘动脉取栓4条肢体,补片成形19条肢体,自体静脉旁路或间位移植2条肢体.人工血管间位移植1条肢体.其中6条肢体在血管重建手术同期行腓肠肌内侧头离断松解术.结果 本组患者手术均获成功,24例患者25条肢体症状改善,间歇性跛行距离延长;术后踝肱指数为0.75±0.29,高于术前的0.35±0.20(P<0.01).随访4～16个月,平均10.2个月,一期通畅率为92.3%;术后截肢3例,保肢率为88.5%.结论 腘动脉闭塞成因复杂,采取个体化手术治疗策略方能获得满意疗效.     

血管腔内成形术治疗髂动脉硬化闭塞症

目的 探讨血管腔内成形术治疗髂动脉硬化闭塞症的临床疗效.方法 回顾性分析2002年12月至2008年12月收治的61例(76条血管)髂动脉硬化闭塞症患者的临床资料,其中男46例,女15例.平均年龄(67±11)岁.主要临床症状包括严重的间歇性跛行(跛行距离<100 m)38例,静息痛13例,肢/趾端溃疡10例.TASC A型病变29例,B型16例,C型11例,D型5例.应用导丝导管或超声消融开通闭塞段,行腔内支架置入术后随访.结果 61例患者71条血管成功开通(共置入63枚支架),开通率93%(71/76).成功者临床症状改善率100%.踝肱指数(ABI)由术前0.33±0.17提高到术后0.72±0.20,差异有统计学意义(P<0.05).随访51例,随访率83%.随访时间6-60个月,平均(26±14)个月.1年通畅率90%(TASC A、B组92%;TASC C、D组84%).3年通畅率75%(TASC A、B组80%;TASC C、D组63%);5年通畅率72%.结论 髂动脉硬化闭塞的腔内成形术较传统的血管重建手术创伤小、并发症低,近、中期通畅率相当.