下肢多平面动脉闭塞症的动脉重建术

探讨下肢多平面动脉闭塞症近远端动脉重建的治疗经验。方法:全组18例,男15,女3,平均67.4岁。通过测定踝/臂指数和经皮动脉穿刺插管造影,确定动脉病变范围。一期实施近、远端动脉重建16例,股-胫后动脉旁路转流2例。结果:全组术前平均踝/臂指数0.4,主、髂、股动脉病变33.3％,股、腘、小腿动脉病变55.6％,髂-小腿全下肢动脉病变11.1％。术后病死率5.6％,截肢率11.1％。术后1月,静息痛症状均得到改善,肢端溃疡愈合,踝/臂指数平均值0.94。平均随访22.5月,近端动脉重建畅通率100％,远端动脉重建畅通率80％,踝/臂指数平均0.85。结论:下肢多平面动脉闭塞症同时行近远端动脉重建安全、有效。手术成功关键在于动脉重建流人、流出道的畅通。

Arterial Reconstruction of Lower Extremity Multi-level Arterial Occlusive Disease.

To evaluate the therapeutic experience of simultaneous proximal and distal arterial by-pass in the treatment of multi-level arterial occlusive disease of the lower extremity. Methods: From May 1994 to September 1997, 18 patients underwent bypass procedure. Fifteen of the patients were male, 3 were female, with an average age of 67.4. All the patients had intermittent claudication, 16 ca-ses had rest pain and 8 cases had ulceration of the digital end(s). The severity of arterial disease was assessed by ankle brachial index(ABI) and percutaneous arteriography. Sixteen cases underwent simultaneous proximal and distal arterial bypass, 2 cases underwent femoro-tibial bypass. Results: All cases had an average preoperative ABI of 0.4. Six cases(33.3%) of the group had lesions of the aorta, and the iliac and femoral arteries, 10 cases(55.6%) had femoral popliteal and tibial arterial lesions, 2 cases(ll.l%) had arterial lesions affecting the whole lower extremity(from iliac to tibial artery). The postoperative mortality rate and amputation rate were 5.6% and 11.1% respectively. One month after operation, ameliorated rest pain and healing of ulceration of the digital end(s) were attested in all the cases, with an average ABI of 0.94. After an average follow-up time of 22.5 months, the proximal arteri-al bypass patency rate was 100%, while the distal patency rate was 80%, with an average ABI of 0.85. Conclusions: It is safe and effective to perform simultaneous proximal and distal arterial reconstruc-tion for multi-level arterial occlusive disease of the lower extremity. The key to the success lies in the fact that the inflow and outflow of the arterial bypass should all be guaranteed.