大隐静脉原位转流术重建下肢血液循环

目的:评价大隐静脉原位转流术治疗下肢动脉硬化闭塞症的疗效.方法:运用自制瓣膜切除器开展大隐静脉原位转流术治疗下肢动脉硬化闭塞症38例共40例肢体.患者术前踝肱指数(ABI)为0-0.58(平均0.29),均经动脉造影证实.术后移植物均可扪及搏动,有28条肢体足背或胫后动脉搏动恢复,17例同时行输入输出道动脉重建术,溃疡清创术6例,4例于术后3天内出现移植物搏动消失,行第2次重建术,结果:ABI平均值同术前0.29上升至0.84,严惩缺血肢体挽救率为100%,经寿命表统计分析,1-5年的血管累积通畅率分别为92%,87%,82%,72%和65%,结论:大隐静脉原位转流术是治疗下肢动脉硬化闭塞症的理想方法之一,同时行输入功输出道动脉重建术,对保证移植血管的通畅有着重要的意义.

In situ saphenous vein arterial bypass for lower limb ischemia

Objective To evaluate the effect of in situ saphenous vein arterial bypass on lower limb ischemia.Methods 38 patients with 40 ischemic lower limbs were treated by in situ saphenous vein femoro distal arterial bypass using self made valvulotome in Zhongshan Hospital from 1989 to 1999. All patients had claudication in the lower extremities and were diagnosed angiographically. The preoperative ABI was from 0 to 0.58 (mean 0.29).Results All the vein grafts were patent postoperatively and the dorsalispedis or posterior tibial arteries were palpable in 28 legs immediately after operation. Seventeen patients had concomitant arterial reconstruction. Graft occlusion within 3 days after original operation occurred in four cases and secondary surgical corrections were successful. Postoperative mean ABI increased from 0.29 to 0.84. The limb salvage rate was 100% and the cumulative patency rates of 1,2,3,4 and 5 years were 92%, 87%, 82%, 72% and 65% respectively by the lifetable analysis.Conclusions The results suggest that the in situ saphenous vein arterial bypass is a superior method for distal reconstruction and the concomitant procedures to ensure sufficient inflow as well as outflow are essential to the patency of the graft.