自体静脉旁路移植术治疗下肢动脉硬化闭塞症疗效分析

目的：探讨自体静脉旁路移植术在治疗下肢动脉硬化闭塞症中的作用。方法回顾性分析2004年1月-2012年7月应用自体静脉旁路移植术治疗的35例伴重症下肢缺血的下肢动脉硬化闭塞症患者的临床资料。所有病例均表现为下肢静息痛和/或溃疡、坏死，术前血管造影显示下肢动脉节段性闭塞为TASC C或D级病变。下肢血流重建采用以自体大隐静脉为移植物的动脉旁路手术。结果35例中34例（97．1％）术后患肢静息痛消失，皮肤温度、颜色明显改善，踝肱指数均值由术前0．11±0．13升为术后0．91±0．23，两者之间差异有显著性意义（P＜0．001）。术后随访30例，随访时间1～5年（平均3．5年），术后1、3、5年移植血管的一期累计通畅率分别为91％、80％、75％，二期累计通畅率分别为95％、83％、77％。结论自体静脉旁路移植术是治疗动脉硬化性重症下肢缺血，挽救患者肢体的有效方法。

Autogenous vein bypass grafts for the treatment of lower limb arteriosclerosis obliterans

Objective To assess the clinical effects of autogenous vein bypass grafts for the treatment of lower limb arterio -sclerosis obliterans .Methods We retrospectively analyzed 35 patients of lower limb arteriosclerosis obliterans with critical lower limb ischemia , for which autogenous vein bypass grafts were performed from January 2004 to August 2012 .Clinical manifestations in these patients were resting pain and /or ulcer/necrosis of the lower limb , in which preoperative angiogra-phy showed segmental TASC C , D occlusive lesions .Blood stream of the lower limb was reconstructed by bypass surgery u-sing autogenous saphenous vein grafts .Results In 34 cases （97.1%） symptoms were relieved, with resting pain disap-peared and skin temperature improved .Ankle brachial index （ ABI） increased significantly from 0.11 ±0.13 to 0.91 ± 0.23 perioperatively （P〈0.001）.Postoperatively, 30 cases were followed up for 1 year to 5 years.The primary graft pa-tency rates in this series were 91%, 80%and 75%in 1 year, 3 years and 5 years, respectively.The secondary graft pa-tency rates were 95%, 83%and 77%in 1 year, 3 years and 5 years, respectively.Conclusion Autogenous vein bypass graft is an effective method for the treatment of lower extremity ischemia due to arteriosclerosis obliterans and the salvage of the limbs.