动脉内膜剥脱术治疗下肢缺血性疾病

目的：探讨动脉内膜剥脱术治疗下肢缺血性疾病，方法：本组22例动脉闭塞症患者，术中在动脉闭塞远端纵行行切动脉，剥离切口处的动脉内膜后横断、将动脉内膜断端套入自帛不锈钢圈套器内，将圈套器向近端推进至闭塞近端，退出圈套器，用Fogarty取栓塞取出动脉内膜，切口处缝合固定远端内膜断端。结果：内膜剥脱长度10－43cm，19例症状完全消失（86．4％），1例股浅动脉内膜剥脱失败而改自行体大隐静脉倒置搭桥术，2例因流出道不良恶性化而截肢，近期通畅率86．4％，无手术死亡。平均随访时间3．2年，2例因动脉血栓形成行导管溶栓术后痊愈，2例切口狭窄闭塞，再次行切口成形术后痊愈。1例因而栓闭塞性脉管炎复发闭塞，出现静脉痛，远期通畅率68．2％。结论：动脉内膜剥脱术仍是治疗下肢缺血性疾病的一种好方法，操作简单，医疗费用低廉，近期通畅率与动脉搭桥术相仿。

Endarterectomy for ischemia of the lower extremity

Objective　To treat ischemia of the lower extremity, endarterectomy was performed.　Methods　In 22 patients with arterial occlusive disease, arteriotomy was performed at the distal end of the occlusive part. Artheroma was freed and cut off. A ring stripper was inserted into the artery and went up to the proximal end of the occlusive lesion. The artheroma was removed by a Fogarty through arteriotomy. The distal end of the cut intima was sutured to the arterial wall.　Results　The removed occlusive lesion was 10 to 43 cm long. Symptoms disappeared in 19 patients (86.4%), and no deaths occurred. Endarterectomy failed in one patient and a bypass was performed with the reversed suphenous vein. Amputation was performed in two patients because of its insufficient run-off. The average time of follow up was 3.2 years, and patients with arterial thrombosis were treated by thrombolytic therapy. Two patients with artery stenosis were cared by vein patch angioplasty. One experienced rest pain after treatment with a long-term patency 68.2%.　Conclusions　Endarterectomy is still a choice of treatment for ischemia of the lower extremity, and it is simple and its patency is similar to that of arterial bypass.