静脉动脉化治疗严重下肢缺血的远期疗效分析

LONG FOLLOW ON VENO-VALVULEOTMY OR VENOUS VALVE FRACTURE AND ONE STAGE IN SITU ARTERIOLIZATION OF THE VEINS FOR TREATMENT OF ISCHEMIC LOWER LIMBS

目的：探索静脉动脉化治疗严重下肢缺血的新术式。方法：在对大隐静脉、胫后静脉瓣膜进行解剖学和生物力学研究的基础上，设计静脉瓣膜切除或破坏、原位一期静脉动脉化两种新术式，治疗动脉广泛闭塞所致严重下肢缺血患者７１例（７４条肢体）。结果：随访１～８年（其中随访５年以上３２例），静息痛消失率９６．５％，间隙性跛行消失率９３．７％，截肢率降至２．７％，获得满意效果。结论：两种新术式通过静脉通道，逆行灌注动脉血，确能改善或重建严重缺血下肢的血循环，具有满意的远期疗效。

Objective:To find a new way to salvage the severe ischemic lower extremity,Methods:After the study of the valvular distribution and function of the great saphenous and posterior tibial veins,performed veno valvulectomy or venous valve fracture and one stage in situ veno arteriolization for 74 severely ischemic limbs of 71 patients with critical continuous rest pain and necrotic lesions of the toes and feet for whom had extensive arterial occlusion of lower limbs Results:After operations,71 patients(74 lower limbs)were followed up for 1 to 8 years,the results were excellent Conclusions:It was undoubted that the retro grade distribution of arterial blood flow thyough venous passages might improve and reconstruct the blood circulation of ischemic limb to salvage impending necrotic limb