下肢动脉人工血管旁路移植术后闭塞的治疗探讨

Treatment of prosthetic graft occlusion of the ischemic lower extremity

目的探讨下肢动脉人工血管旁路移植术后闭塞的治疗及效果。方法选择下肢动脉人工血管旁路移植术后闭塞患者67例,采用单纯药物抗凝(袪聚)治疗(11例)、单纯人工血管切开取栓术(20例)、人工血管取栓+吻合口扩大成形术(29例)及人工血管或自体大隐静脉再移植手术(7例)。结果围手术期无严重并发症及手术死亡。59例获得随访,8例失访,随访率为88.1%。平均随访34.4个月。所有再手术病例6个月内均通畅良好。随着随访时间的延长,有25例患者(30条下肢)有效降低截肢平面,其余患者下肢缺血症状均有不同程度改善。结论根据患者病情通过依序选择药物治疗及手术等方法治疗下肢动脉人工血管旁路移植术后闭塞,疗效满意。

Objective To explore the optimal strategies for occluded prosthetic bypass of the ischemic lower extremity. Methods From October 1999 to April 2007 67 patients suffered from recurrent ischemic symptom of lower extremity due to prosthetic graft failure were reviewed retrospectively, clinical characteristics of these patients were identified in detail. The indications for the treatment were severe claudication, rest pain or gangrene in all of the patients. The treat-ment included： antiplatelet and anticoagulant therapy （11 cases）, only thrombectomy （20 cases）, thrombectomy and anasto- mosis site reconstruction （29 cases）, new bypass （7cases）. Results There was no postoperative and mortality. 59 patients （88.1%） complication were followed, the mean following-up period was 34.4 months. During the follow-up, all of the patients suffered from second surgical treatment had 6 months graft patency. The amputating level was lowered in 25 eases with 30 extremities. Among the other cases, the ischemic symptoms were relieved or disappeared. Conclusions Antiplatelet and anticoagulant therapy and/or surgical operation should be adopted acconding to the ischemic status in the treatment of prosthetic graft occlusion of lower extremity artery.