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。

Bypass grafting for the treatment of critical lower limb ischemia with distal single outflow artery:an analysis of 39 cases

Objective To evaluate a bypass surgery for the treatment of critical lower limb ischemia. MethodsFourty-five limbs in 39 patients with single outflow artery underwent arterial bypass graft, including femoropopliteal artificial graft to single outflow artery with autograft in 21 limbs (46.7%) and popliteal artery to calf vessel in 10 limbs (22.2%). Results Among 39 patients, one died of respiratory failure 5 days post-op (death rate 2.6%); one suffered from artificial graft occlusion (2.6%). The patency rate of graft was 100% on discharge. Healing rate of foot ulcer was 30%. Conclusions It is difficult to reconstruct blood flow for critical ischemic limb with single outflow artery, but good result is still expected by distal lower limb bypass graft. Distal bypass can result in a limb salvage or lowering of amputation level, providing a better nutritional support for the healing of foot ulcer.