血管镜下原位下肢动脉旁路术

Angioscopic In-situ Arterial Bypass of Lower Extremities

作者经对27条肢体行动脉重建术,证明血管镜直视下可完全切开静脉移植物瓣膜,可准确定位结扎静脉属支,从而避免了术后动静脉瘘,避免了全程游离大隐静脉所造成的热缺血损伤并发症。血管镜可在术中监控移植物和吻合口质量。作者所设计应用的”复合移植物”和“共同流出道”技术有效地提高了静脉移植物的使用率,扩大了流出道的吻合口径和血流量。本组肢体救治率为25/27肢,在2～13个月随访期间吻合口均通畅,踝压由术前25.5±1.2mmHg上升为术后40.2±0.4mmHg,趾压由16.0±0.3上升为28.3±1.1(均值±S)。表明本手术在下肢动脉重建中具有良好的实用价值和独特的优点。

Authors initial experience of angioscopic in-situ arterial bypass of 27 extremities reveals that angioscopy can be used to assist complete valvular ablation and precise location and iigation of tributaries of saphenous vein grafts, avoiding postoperative arterial-venous fistula and warm ischemic injury to the grafts. Angioscopy is also useful to perform intraoperative completion inspection of the grafts and anastomoses. The designed'composite graft 'and 'common ostium'Ttechnique promotes the usage rate of the limited autogenous vein grafts and enlarges the diameter and blood flow through the distal anastomosis. Because of the above new series of procedures, the extremity salvage rate in this study is 25/27 limbs. During the followup period of 2 ~ 13 months, all anastomoses are patent. The preoperative ankle and toe pressure of 20.5+L2 and 16.0+0.3 mmHg(mean+S) respectively rises to 40.2+0.4 and 28.3+1.1mmHg postoperatively. The conclusion of this study is that the angioscopic in-situ arterial bypass surgery is of practical value and special advantages in the lower extremity salvage.