血管重建治疗注射毒品所致股动脉假性动脉瘤

Surgical revascularization for femoral pseudoaneurysms in drug addict patients

目的探讨注射毒品所致股动脉假性动脉瘤的外科治疗方法。方法对14例注射毒品所致股动脉假性动脉瘤患者的临床资料进行回顾分析。9例直接采用ePTFE人工血管行原位移植间置术;4例采用自体大隐静脉原位间置移植术;1例行单纯股深动脉结扎术。结果全部病例术后患肢供血良好,无肢体缺血表现,其中11例患者成功随访1～45个月,1例患者出院后出现伤口感染,余患者伤口均在1个月内愈合,现患肢均无缺血症状,活动自如。结论吸毒所致股动脉假性动脉瘤切除后血管重建有利于保证下肢血供,在患者不能提供合适的自体大隐静脉移植时,人工血管原位移植仍是治疗假性股动脉瘤的有效方法。术中彻底清创及术后伤口引流、加强抗炎是预防术后人工血管并发感染的最主要措施。

Objective To evaluate surgical treatment of femoral pseudoaneurysms caused by injection of addictive drugs. Methods Clinical data of 14 cases of femoral pseudoaneurysm caused by injection of addictive drugs were reviewed retrospectively. Nine patients underwent revascularization with expanded polytetrafluoroethylene （ePTFE） in situ;4 patients underwent revascularization with autologous saphenous vein in situ ; 1 patient underwent ligation of profunda femoral artery. Results The distal blood flow of all patients was patent immediately after operation. Eleven patients were followed up for 1 to 45 months, 1 patient had incision infection after discharge and it healed through aggressive antibiotic therapy; the other patients were asvmotomatic. Conclusions Revascularization with resection of pseudoaneurysm is an effective procedure for blood supply of limbs in the drug addict patients. When a suitable saphenous vein is not available for transplantation in situ, an artificial vessel graft is still an effective procedure for managing femoral pseudoaneurysms in the drug addict patients. Thorough debridement and avoidance of artificial vessel contamination during operation and sufficient drainage and aggressive antibiotic therapy after operation are the most important factors for preventing infective complications of the graft.