解剖外动脉旁路移植术治疗主髂动脉闭塞症

目的 探讨解剖外动脉旁路移植术在治疗主髂动脉闭塞症中的作用.方法 回顾性分析经解剖外动脉旁路移植术治疗的41例主髂动脉闭塞症患者的临床资料,其中有间歇性跛行11例,下肢静息痛12例,合并溃疡或坏疽18例.15例腹主动脉和(或)双侧髂动脉闭塞者采用腋-股动脉旁路移植术,18例单侧髂动脉闭塞者采用股.对侧股动脉旁路移植术,8例单侧髂动脉合并同侧股动脉闭塞者采用股.对侧胭动脉旁路移植术.使用的旁路移植血管均为聚四氟乙烯(Gore-Tex)人工血管.结果 术后40例(97.6%)患者的临床表现明显改善.踝肱指数由术前0.41±0.15升为术后0.89±0.21,两者比较差异有统计学意义(P<0.05).随访35例,随访时间1～5年,本组术后1、3、5年移植血管的总的通畅率分别为93%、86%、80%.结论 解剖外动脉旁路移植术具有创伤小,术后恢复快等优点,是治疗主髂动脉闭塞症的有效方法之一.

Extra-anatomic arterial bypass grafting in the management of aorta-iliac occlusive disease

Objective To study the role of extra-anatomic arterial bypass grafting in the management of aorta-iliac occlusive disease. Methods Forty-one cases of aorta-iliac occlusive disease managed by extra-anatomic arterial bypass grafting were retrospectively analyzed. Clinical features included claudicafion 11, resting pain 12 and ulcer/gangrene 18 patients. Axillofemoral bypass was performed in 15 cases with aortic and bilateral iliac artery occlusion, femorofemoral bypass in 18 cases with unilateral iliac occlusion and femoro-cnntralateral popliteal bypass in 8 cases with iliac and ipsilateral femoral artery occlusion. Results Postoperatively, clinical features were reheved in 40 cases (97.6%). Ankle brachial index increased significandy from 0.41 ± 0.15 to 0.89 ± 0.21 perioperatively (P < 0.05 ).Thirty-five cases were followed up for 1 year to 5 years. The overall graft patency rates in this series were 93%, 86% and 80% in 1, 3 and 5 years, respectively. Conclusion Extra-anatomic arterial bypass has merits as less invasive and rapid postoperative recovery, and this is one of the effective methods for the treatment of aorta-iliac occlusive disease.