分期静脉动脉化治疗肢体动脉广泛性闭塞的评价

Revascularization of severely ischemic limbs by staged arteriovenous reversal

目的：评价分期静脉动脉化治疗肢体动脉广泛性闭塞的疗效。方法：自１９８４年１月至２０００年１１月，共手术１４９例，１６４条下肢。ＡＳＯ患肢３３条，ＴＡＯ １３０条。采用３种不同术式：①深组高位：在髂－股动脉与股浅静脉间建立ＡＶＲ；②深组低位：在 动脉与胫腓干静脉间建立ＡＶＲ；③浅组：在 动脉与大隐静脉远侧段之间建立ＡＶＲ。结果：１５２条患肢随访４个月～１６年，平均８年左右。除１２条患肢外，１４０条患 效满意或病情改善。结论：深组高位应慎重选择合适的病例，深组低位效果最好，浅组已不再采用。分期ＡＶＲ为治疗肢体动脉广泛闭塞症开辟一条新途径。【

Objective:To assess staged arteriovenous reversal in the treatment of extensive and diffuse arterial occlusive disease of the limb. Methods :From January 1984 to November 2000,149 patients (164 lower limbs) were operated on with staged arteriovenous reversal. According to the different levels of the extensive and diffuse arterial occlusion, the arteriovenous reversal was formed on three different sites:(1)high-deep reversal,produced between the external lilac,common femoral,or superficial femoral artery and the superficial femoral vein;(2) low-deep reversal,made between the distal popliteal artery and the tibioperoneal venous trunk; and (3)superficial reversal,established between the distal popliteal artery and the distal portion of the long saphenous vein. Results:until February 2001,143 patients (152 lower limbs) were follow up for 4 months to 16 years, averaging 8 years. The postoperative results of all limbs except 12 in this series were good or satisfactory. Cardiac dysfunction does not occur, nor does the marked elevation of venous pressure of the limb. Conclusion :The staged arteriovenous reversal is an effective approach in the treatment of extensive arterial occlusive disease of the limb.