缺血肢体血管旁路治疗的探讨

目的 探讨提高血管旁路转流术治疗肾动脉平面以下动脉缺血的临床效果及途径.方法 对应用人工血管和自体大隐静脉行旁路移植术治疗下肢动脉缺血的17例患者进行总结,分别于肾动脉水平以下的腹主动脉至双髂总动脉、腹主动脉至双髂外动脉、髂总动脉至腘动脉、股总动脉至腘动脉上段、股总动脉至腘动脉下段、腘动脉与胫后动脉行架桥术.结果 其中行大隐静脉架桥术的5例患者血管全部通畅,股三角淋巴瘘1例;行人工血管架桥术的12例患者中,伤口液化5例,人工血管外露并阻塞1例,隐神经皮支损伤1例.结论 腹主动脉、双髂动脉或双股动脉闭塞只能采用人工血管架桥术治疗;股总动脉以下股浅动脉以及腘动脉闭塞,人工血管和自身血管性架桥均可应用;而腘动脉下段及膝关节以下的动脉闭塞时,采用自体大隐静脉架桥;动脉造影是正确选择血管重建方式的可靠保证.

Clinical experience of treatment for arterylimb ischemia by vascular bypass

Objective To investigate the method of improving clinical effect of vascular bypass surgery in the treatment of infra-renal artery ischemic disease. Methods 17 cases of lower extremity ischemia treated with vascular bypass were analyzed. The vascular bypass located from abdominal aorta infer-renal vascular to both common iliac artery, from abdominal aorta to both external iliac artery, from common iliac artery to popliteal artery, from femoral artery to superior segment of popliteal artery, from femoral artery to inferior segment of popliteal artery, from popliteal artery to posterior tibial artery. Results All great saphenous vein bypasses of 5 patients were easy and smooth, one of which developed femoral triangle lymphatic fistula. Among the 12 patients with vascular prosthesis bypass, 5 occurred fat eliquation in wound and vascular prosthesis exposed and obstructed, 1 nervous saphenous cutaneous branches injured. Conclusion Vascular prosthesis was the only choice for the treatment of the obstruction of abdominal aorta, double arteria iliaca and double femoral artery. As to superficial femoral artery and popliteal artery inferior to common femoral artery, both prosthesis and auto vascular could be used. Auto great saphenous vein bypass would be better choice for the occlusion of inferior segment of popliteal artery inferior to articulation of knee. Arteriography is a guarantee of choosing the right vascular reestablishment method.