复合血管序贯式旁路移植术治疗慢性肢体缺血的临床分析

Clinical analysis of composite sequential bypass graft for treatment of chronic limb ischemia

目的探讨复合血管序贯式下肢动脉旁路术治疗慢性下肢缺血的效果。方法回顾性分析3年内采用复合式血管序贯式动脉血管重建的2 5例慢性下肢缺血患者的临床资料。复合血管由聚四氟乙烯(PTFE)人工血管及自体静脉组合而成。PTFE近心端与股总动脉吻合,远端与孤立腘动脉吻合;自体静脉从PTFE血管远端发出并与小腿的胫或腓动脉吻合。结果自体静脉远端吻合口止于胫前动脉5例,胫后动脉8例,腓动脉1 2例。术后1,2,3年累积通畅率分别为7 8%,7 2%,6 1%。二期累积通畅率分别为8 3%,7 7%,6 8%。救肢率分别为8 3%,8 3%,7 3%。结论复合血管序贯旁路术治疗慢性肢体缺血远期通畅率较高,具有较好的救肢效果,是解决自体静脉不足的合理选择。

Objective To evaluate the outcome of composite sequential bypass in treatment of chronic lower extremity ischemia. Methods The clinical data of 25 patients with chronic lower limb ischemia who underwent composite sequential bypass reconstruction, in a 3-year period, were retropectively analyzed. The composite vessel consisted of PTFE vassular prosthesis and autologous vein. The proximal end of PTFE was anastomosed to the common femoral artery, and the distal end to the isolated popliteal artery. The autologous vein exited from the lower end of PTFE vessel and was anastomosed to the tibial or peroneal artery in the leg. Results The venous reconstructions had the inflow taken from the distal PTFE artery （above knee in 5 and below knee in 20）. The outflow involved the peroneal artery in 12 （48%） , the posterior tibial artery in 8 （32%） , and the anterior tibial artery in 5 （20%）. Primary patency, secondary potency and limb salvage were 61% , 68 % and 73 % at 3 year, respectively. Conclusions Composite sequential reconstruction using an isolated popliteal segment as supporting point for the distal reconstruction has high long-term patency rate and good effect of limb savage, it is an acceptable option in patients presenting with serious limb ischemia without enough venous conduit for distal bypass.