髂外-腘动脉人工血管交叉转流术治疗髂股动脉硬化闭塞症

External iliac-popliteal artery artificial graft cross bypass for the treatment of arterial occlusion in lilac-femoral arteriosclerosis

目的探讨髂外动脉-腘动脉人工血管移植交叉转流术治疗单侧髂股动脉硬化广泛性闭塞的疗效。方法1999年9月至2007年10月39例患者经血管彩超、CT血管造影（CTA）或数字减影血管造影（DSA）检查，证实单侧髂股动脉硬化广泛性闭塞；静息痛25例，14例足趾溃疡或坏疽，平均踝／肱指数0．19；采用健侧髂外动脉-患侧腘动脉人工血管移植交叉转流术，左转至右22例，右转至左17例。结果围手术期无死亡及截肢患者。踝／肱指数由术前平均0．19术后升至0．94；术前以80m／min速度行走，跛行距离15～60m，术后（100～120）m／min行走，距离增至350～500m或〉500m；术后血管彩超检测腘动脉平均血流速为45crn／s，胫前（后）动脉术前极少量血流信号，术后平均血流速41em／s。35例（89．7％）平均随访3．4年，3年一二期累计通畅率85．7％，其中4例截肢，保肢率88．6％。结论髂外动脉-腘动脉人工血管移植交叉转流术是治疗单侧髂股动脉闭塞可行有效的方法，尤其适宜全身状态较差，合并有重要器官病变的老年患者。

Objective To study the curative effectiveness of external iliac-popliteal artery artificial graft cross bypass in treating extensive arterial occlusion in unilateral iliae-femoral arteriosclerosis. Methods From Sep. 1999 to Oct. 2007, 39 elder patients were diagnosed as having extensive arterial occlusion in unilateral iliac-femoral arteriosclerosis by color Doppler uhrasonography, CTA or DSA. 25 patients （61.5%） had resting pain, 14 had ulcers or gangrenes in the toes. The average ankle-brachial index was 0. 19. Contralateral external iliac-popliteal artery artificial graft cross bypass surgeries were performed on 22 patients from left to right, the other 17 were from right to left. Results There were no perioperative death or amputation. The ankle-braehial index increased from 0 - 0. 41 （ preoperative ） to 0. 85 - 1.02（ postoperative ）; the elaudieation distance increased from 15 - 60 m （preoperative） to 350 - 500 m or more than 500 m [postoperatively at the speed of （100 - 120） m/min] ; The postoperative color Doppler ultrasonography showed the average velocity of the popliteal artery was 45 cm/s. In the anterior tibial artery or the posterior tibial artery, little blood flow was showed in preoperative color Doppler ultrasonography examination, the postoperative average blood flow velocity was 41 cm/s. 35 patients （89. 7% ） were followed up for an average of 3.4 years, with an accumulative patency rate of 85.7%. Four patients had amputation, the limb salvage rate is 88.6%. Conclusion External iliae-popliteal artery artificial graft cross bypass is effective in treating unilateral iliac-femoral arterial occlusion, particularly for aged patients with vital organ incompetence.