自体大隐静脉倒置旁路转流术治疗下肢血栓闭塞性脉管炎

目的:探讨自体大隐静脉倒置旁路转流术治疗下肢血栓闭塞性脉管炎的疗效.方法:回顾性分析2007年1月-2012年5月采用自体大隐静脉倒置旁路转流术治疗下肢血栓闭塞性脉管炎21例患者临床资料,其中行股浅动脉-胫后动脉旁路转流术9例,股浅动脉-腓动脉旁路转流术5例,股浅动脉-腘动脉远端旁路转流术4例,腘动脉-胫后动脉旁路转流术3例.结果:1例拟行股浅动脉-胫后动脉旁路转流术患者术中证实远端流出道差而终止手术,20例完成手术,成功率为95.2％.患者术后肢体远端血供均改善、静息疼消失、间隙性跛行距离延长、溃疡愈合；平均踝肱指数(ABI)由术前0.46±0.12上升到术后1.05±0.07 (P＜0.001).18例获得随访5～59(30.6±7.5)个月,治疗效果稳定.结论:自体大隐静脉倒置旁路转流术是存在远端流出道的血栓闭塞性脉管炎患者有效的治疗方法.

Reversed autogenous saphenous vein bypass for thromboangiitis obliterans of lower extremities

Objective: To evaluate the therapeutic efficacy of reversed autogenous saphenous vein bypass for thromboangiitis obliterans of the lower extremities. Methods: The clinical data of 21 patients with thromboangiitis obliterans undergoing reversed antogenous saphenous vein bypass grafting from January 2007 to May 2012 were retrospectively analyzed. Of the patients, 9 cases underwent superficial femoral-posterior tibial bypass grafting, 5 cases underwent superficial femoral-peroneal bypass grafting, 4 cases underwent superficial femoral-distal popliteal bypass grafting, and 3 cases underwent popliteal-posterior tibial bypass grafting. Results: Attempt of superficial femoral-posterior tibial bypass procedure in one patient was aborted due to inefficient outflow found at the time of surgery. The operation was accomplished in 20 patients, so the success rate was 95.2%. After surgery, the patients showed improvement of the distal blood supply of the affected leg, no rest pain, prolongation of intermittent claudication distance, and ulcer healing. The average ankle brachial index (ABI) was increased from 0.46±0.12 before surgery to 1.05±0.07 after surgery (P<0.001). Eighteen patients were followed up for 5 to 59 months with an average of (30.6±7.5) months, and the improvements in these patients were sustained. Conclusion: The reversed antogenous saphenous vein bypass is an effective treatment for thromboangiitis obliterans of the lower extremities in patients with available outflow.