髂外-腘动脉人工血管交叉转流术治疗髂股动脉硬化闭塞症

目的 探讨髂外动脉-腘动脉人工血管移植交义转流术治疗单侧髂股动脉硬化广泛性闭塞的疗效.方法 1999年9月至2007年10月39例患者经血管彩超、CT血管造影(CTA)或数字减影血管造影(DSA)检查,证实单侧髂股动脉硬化广泛性闭塞;静息痛25例,14例足趾溃疡或坏疽,平均踝/肱指数0.19;采用健侧髂外动脉-患侧胴动脉人工血管移植交叉转流术,左转至右22例,右转至左17例.结果 围手术期无死亡及截肢患者.踝/肱指数由术前平均0.19术后升至0.94;术前以80 m/min速度行走,跛行距离15～60 m,术后(100～120)m/min行走,距离增至350～500 m或>500 m;术后血管彩超检测胭动脉平均血流速为45 cm/s,胫前(后)动脉术前极少量血流信号,术后平均血流速41 cm/s.35例(89.7%)平均随访3.4年,3年一二期累计通畅率85.7%,其中4例截肢,保肢率88.6%.结论 髂外动脉-腘动脉人工血管移植交叉转流术是治疗单侧髂股动脉闭塞可行有效的方法,尤其适宜全身状态较差,合并有重要器官病变的老年患者.     

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     

髂动脉支架联合股动脉内膜剥脱术治疗多节段髂股动脉闭塞症

目的 探讨多节段髂股动脉闭塞症的治疗手段及临床疗效.方法 选择2008年1月2011年6月间采用髂动脉支架植入联合股动脉内膜剥脱+补片成形术治疗的多节段髂股动脉硬化闭塞症36例患者,其中男性26例,女性10例;年龄49～ 87岁,平均65岁.对患者的随访结果进行回顾性分析,评价术前、后患者临床症状改善情况,采用Kaplan-Meier生存分析比较不同Fontaine分级患者间一期通畅率的差异,采用Cox回归分析筛选影响一期通畅率的独立因素等.结果 本组患者手术均获成功,术后34例(94.4％)临床症状得到明显改善.平均随访24.2个月,一期通畅率为72.2％,辅助一期通畅率为83.3％,二期通畅率为94.4％.生存分析显示FontaineⅡ级患者一期通畅率明显高于Ⅲ、Ⅳ级患者(P =0.041、0.012).Cox回归分析未发现影响术后一期通畅率的独立因素.结论 髂动脉支架植入联合股动脉内膜剥脱+补片成形术是治疗多节段髂股动脉闭塞症的有效方法,随访结果良好.     

股-股深动脉人工血管旁路术治疗单侧长段髂股动脉硬化闭塞症

目的 评价股-股深动脉人工血管移植旁路术治疗单侧髂股动脉长段硬化闭塞症的长期疗效.方法 回顾性分析1995年7月至2010年12月收治的40例单侧长段髂股动脉硬化闭塞症患者的临床资料,其中男28例,女12例;年龄66 ～ 90岁,平均(73±6)岁.所有患者的诊断经CT动脉造影证实,单侧髂总动脉,髂外动脉,股总动脉和股浅动脉硬化闭塞.均采用股-股深动脉人工血管旁路术治疗,术前、后检测血管流速,踝/肱指数.使用Kaplan-Meier方法分析5、7、10年累积通畅率和5、7、10年保肢率.结果 本组患者在围手术期无死亡和截肢.35例(87.5％)随访1 ～13年,平均(5.7±2.8)年.ABI由术前平均0.23±0.10升至术后0.55±0.11,差异有统计学意义(t=15.91,P=0.000).术前彩超检测腘动脉及胫动脉平均血流速度分别为(14±6)cm/s和(10±4) cm/s,术后分别升至(34±10)cm/s和(22±7)cm/s.术后5、7、10年一二期累计通畅率分别为:60.1％,44.3％,25.3％和93.5％,86.8％,57.9％.术后5,7,10年保肢率分别为:97.5％,95％和90％.结论 治疗单侧髂股动脉长段闭塞症,股-股深人工血管旁路术安全有效,本术式可用于不适合腔内治疗和开腹手术的患者.     

主髂动脉闭塞症的重建术术式选择

为探索主髂动脉闭塞重建手术方式选择的规律，作者对３１例不同类型的主髂动脉闭塞症患者分别采用动脉硬化内膜切除术、主－髂或主－股动脉旁路术、解剖外途径动脉旁路术和顺序动脉旁路术治疗。手术死亡率为３．２％。五年通畅率为８４．２％；二期五年通畅率为９６．５％。作者认为踝／肱指数对正确掌握动脉重建术指征有肯定意义。     

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     

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。     

腋-双股动脉旁路转流术治疗主髂动脉硬化闭塞症的手术配合

对5例主髂动脉硬化闭塞症患者行腋-双股动脉旁路转流手术,手术顺利,术后1个月复查踝肱指数(ABI),ABI上升至0.68～0.82;术后随访1年,人造血管通畅.提出手术室护士做好术前访视及术前器械物品准备,术中正确安置体位,严格无菌操作,熟练配合手术,是减少术后并发症、保证移植血管再通良好的必要条件.     

腋-双股动脉旁路转流术治疗主髂动脉硬化闭塞症的手术配合

对5例主髂动脉硬化闭塞症患者行腋-双股动脉旁路转流手术,手术顺利,术后1个月复查踝肱指数（ABI）,ABI上升至0．68～0．82;术后随访1年,人造血管通畅。提出手术室护士做好术前访视及术前器械物品准备,术中正确安置体位。严格无菌操作,熟练配合手术,是减少术后并发症、保证移植血管再通良好的必要条件。     

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。     

Current Therapeutic Options in the Management of Superficial Femoral Artery Occlusive Disease

The management of superficial femoral artery occlusive disease remains challenging for vascular surgeons. Despite the advances and dramatic changes we have seen in modern practice with the development and introduction of new endovascular techniques, long-term results with these interventions remain disappointing when compared to the “gold standard” of a vein bypass with a good run-off. Furthermore, there is little Level 1 evidence to guide us with regards to the best treatment strategy. In this article, we review some of the currently available open surgical and endovascular options for the management of superficial femoral artery disease.     

Ultrasonic Endarterectomy for Long Superficial Femoral Artery Atherosclerotic Occlusive Disease

OBJECTIVE: To report the long term results of ultrasonic superficial femoral artery endarterectomy (USFAE). DESIGN: Retrospective study. PATIENTS AND METHODS: From January 1998 to June 2004 218 USFAE were performed in 202 selected patients (178 males, 192 procedures) with a median age of 65 years (46-87 years). Indications for operation were disabling intermittent claudication in 137 procedures (68%), rest pain in 24 procedures (12%), and limb salvage in 41 procedures (20%). The new medical technology of ultrasonic endarterectomy is based on the application of the mechanical vibrations in the range of low frequency ultrasound. The ultrasonic device consists of the ultrasonic generator, acoustic unit and the flexible wave concentrators with special working tips in the shape of a ring. Follow up consisted of clinical evaluation, ankle-brachial index measurements and duplex scanning. RESULTS: The mean follow-up time was 30.1 months. The mean length of the endarterectomised SFAs was 29 cm (range, 15-43 cm). The five year cumulative primary patency rate by means of life table analysis was 45.8 +/- 4.4% (SE). Percutaneous transluminal balloon angioplasty and surgical re-interventions were performed in thirty three and five patients respectively resulting in a primary assisted patency rate of 57.5 +/- 4.1%. The five year secondary patency rate was 65.6 +/- 3.8%. Limb salvage was achieved in 35 of the 41 patients with gangrene. CONCLUSIONS: The long term results of ultrasonic SFA endarterectomy suggest this is an effective technique.     

多节段动脉硬化闭塞症的外科治疗

目的　探讨下肢多节段动脉硬化闭塞症外科治疗的临床经验。　方法　术中行髂动脉腔内微创技术 (球囊扩张和支架植入 ) ,并同时行肢体远端动脉重建术治疗广泛多节段动脉硬化闭塞症 47例 ( 5 8条肢体 )。　结果　术中 5 3条髂动脉球囊扩张和支架植入均获成功 ,微创治疗技术成功率 10 0 % ;同时行远端动脉重建 5 8条肢体 ,其中包括 :股 -动脉人工血管旁路术 40条肢体 ;深动脉内膜剥脱或补片扩大成形术 18条肢体。股 -动脉人工血管旁路术后踝肱指数平均 0 .77± 0 .13 ( 0 .5～ 1.2 ) ,与术前相比有显著性差异 (P <0 .0 1)。股深动脉扩大成形术后踝肱指数 0 .41± 0 .15 ( 0 .2～ 0 .5 6) ,与术前相比有提高 (P <0 .0 5 )。死亡 1例 (占 2 .1% ) ,其余无严重并发症。平均随访 2 1( 3～ 42 )个月 ,髂动脉支架一期通畅率为 98.1% ( 5 1 5 2 ) ,二期通畅率为 10 0 % ( 5 2 5 2 ) ,股 -动脉人工血管一期通畅率为 87.2 % ( 3 4 3 9) ,二期通畅率为 94.9% ( 3 7 3 9)。截肢率 3 .4% ( 2 5 8)。　结论　术中髂动脉腔内微创介入治疗结合远端动脉重建术是治疗严重多节段动脉硬化闭塞症安全、有效方法     

急性肢体动脉栓塞103例分析

目的：回顾性分析急性肢体动脉栓塞的原因、部位、诊断与治疗方法及术后并发症的预防和处理。方法：经动脉切开，导管取栓，共治疗103例110条肢体，其中上肢11条，下肢99条。7例合并动脉硬化狭窄性病变同时行动脉重建术。结果：8例手术后早期死亡，11例术后仍需截趾或截肢。结论：为防止误诊，对疑有肢体动脉栓塞应施行彩色多普勒检查；早期手术取栓可明显阻止血栓的蔓延，减少肢体坏死的危险。     

Increased Incidence of Lower Limb Amputation for Arterial Occlusive Disease

The number of amputations in Malmohus county with just over 500000 inhabitants had increased from 14 to 161 during the years 1910-79 measured each fifth year comprising totally 724 observations. the number of amputations compared to the age related incidence 1979 had increased four times. Age, diabetes mellitus and sex proportions of ischemic amputees were studied and compared to other Scandinavian reports over the last 30 years. the proportion of diabetic amputees (0.37) and the male proportion (0.54) seemed unchanged, but the proportion of amputees at least 80 years old had increased from about 0.09 to 0.38.     

The Comparison of Long-Term Results between Aortofemoral and Axillofemoral Bypass for Patients with Aortoiliac Occlusive Disease

Purpose: We evaluated the clinical outcomes of aortofemoral bypass (AoFB) and axillofemoral bypass (AxFB) surgeries for complex aortoiliac occlusive disease (AIOD) and compared them from the perspectives of safety and efficacy.Methods: We retrospectively reviewed 21 patients with AoFB grafting and 9 patients with AxFB grafting. The demographic information of the patients was examined, and the intra-, peri-, and postoperative results as well as long-term outcomes were evaluated.Results: In the AoFB, 2 of 21 (9.5%) cases had intra- and perioperative complications, and 4 of 21 (19.0%) cases had postoperative complications; however, there were no postoperative mortalities. In the AxFB, two of nine (22.2%) cases had postoperative graft thrombosis; however, again there were no postoperative mortalities. According to Kaplan–Meier analysis, the primary patency rates in the AoFB and AxFB groups at 5 years were 94.8% and 53.6%, respectively (P = 0.001), while the limb salvage rates at 5 years were 96.4% and 92.9%, respectively (P = 0.320).Conclusions: Even though the patency rates with AxFB grafting were inferior to those with AoFB grafting, AxFB was able to achieve equivalent limb salvage rates and should thus be considered as an alternative treatment method, especially when limb salvage is a goal.     

完全腹腔镜下主-双股动脉旁路术治疗主、髂动脉硬化闭塞症

目的探讨完全腹腔镜下主一双股动脉旁路术治疗主、髂动脉硬化闭塞症的安全性和可行性。方法2008年11月～2012年11月,完全腹腔镜下主一双股动脉旁路术连续治疗7例主、髂动脉硬化闭塞症。7例均为男性,年龄52—70岁,平均60．6岁。Rutherford分级3级5例,4级I例,5级1例。主、髂病变TASC分级C级2例,D级5例。全麻,先用完全腹腔镜技术经左侧结肠后肾后入路游离肾下腹主动脉,再将“Y”形涤纶人工血管近端与之行端侧吻合,人工血管远端经腹膜后隧道引出至相应侧腹股沟,直视下分别与双侧股动脉吻合。结果5例顺利完成腹腔镜下主一双股动脉旁路术,2例中转开腹（肠系膜下动脉断端的钛夹脱落出血1例,结肠损伤1例）。手术时间420～840rain（中位数585min）,主动脉吻合时间40～150min（中位数65rain）,术中出血量400—1500ml（中位数800m1）。未中转的5例均在术后12—40h恢复进食,术后顺利康复出院。结肠损伤患者术后结肠漏二次开腹手术,结肠漏治愈,术后46天死于呼吸衰竭。一过性左肾积水1例,治愈。吻合口近端腹主动脉残留重度狭窄1例行支架治疗治愈。无症状的部分左肾梗死1例。6例随访2—51个月,平均11．2月,均健在,超声随访移植物均通畅,静息痛和间歇跛行症状均消失。结论完全腹腔镜下主一双股动脉旁路术治疗主、髂动脉硬化闭塞症是安全、可行的。在学习曲线中及时中转保证手术安全是必要的。     

Age, Diabetes and Smoking in Lower Limb Amputation for Arterial Occlusive Disease

The increased number of amputations for arterial occlusive disease noted in western countries is only partly explained by increasing numbers of the elderly. A prospective analysis of the influence of diabetes and smoking habits was therefore carried out. in 1978-81, 188 lower limb amputees in Lund were examined and classified as non-smokers, ex-smokers, light smokers and heavy smokers. These figures were compared with corresponding figures among age-correlated controls and to a group of hip fracture patients. the material was divided into men and women and into non-diabetics and diabetics. Smokers had much lower mean age at amputation. Out of 188 amputees only 23 were not either a diabetic, a smoker or 80 years or more. the population study indicates a correlation between smoking and amputation for ichaemia. the coincident increase in cigarette consumption in Sweden is illustrated and it is suggested that smoking should be noted as routinely as diabetes at amputations.