静脉动脉化手术治疗下肢严重缺血症的临床应用价值

Venous arterialization for treating lower limbs ischemia

目的探讨静脉动脉化手术治疗下肢严重缺血症（CLI）的临床应用价值。方法回顾性分析2000-01-2011-12行静脉动脉化手术治疗91例患者的临床资料，其中血栓闭塞性脉管炎70例，动脉硬化闭塞症21例。术前踝／肱指数（ABI）0—4．9（平均3．5）。手术采用高位深组30例，低位深组32例，浅组29例（其中双向血流组22例，直接转流组7例）。结果手术成功率达100％。随访6—60个月，77例患者恢复正常生活，无静息痛存在，间歇性跛行消失或无痛行走距离大于500m。深组4例患者在术后1年出现移植物闭塞，行截肢术。随访期问，10例患者彩超检查出现移植物闭塞，但元临床症状。总救肢率为95．6％（87／91）；有效率为84．6％（77／91）；移植物长期通畅率为84．6％（77／91）。结论静脉动脉化是应用于下肢动脉广泛性闭塞，远端无良好流出道而无法进行常规动脉旁路重建，肢体濒临坏死患者的手术方法，是一种非常规的救肢术式，如适应证选择恰当，手术操作规范，可取得良好疗效。

Objective To assess the clinical effectiveness of venous arterialization in the treatment of pa- tients with critical limb ischemia（CLI）. Methods From January 2000 to December 2011,91 patients with CLI, in- cluding 70 cases with thromboangiitis obliterans and 21 artherosclerosis obliterans, underwent venous arterializations. Ankle-brachial index（ ABI ） was 0 - 4. 9 （ average 3.5 ） before operation. According to the different levels of the arteri- al occlusion,3 kinds of venous arterialization were performed： high deep venous arterialization group（n = 30） ：rever- sal produced between the common or superficial femoral artery and superficial vein;low deep venous arterialization group（n =32）：reversal produced the pophteal artery and the tibiaperoneal venous trunk; superficial venous arterial- ization group（ n = 29 ） ：reversal produced between the femoral or popliteal artery and the distal potion of the long sa- phenous vein. Results The technical success rate was 100%. All cases were followed up for 6 - 60 months, and 77 cases of them achieved satisfied results with disappearance of rest pain and absence of intermittent elaudieation or elaudication distance 〉 500 meters. In high deep venous arterializations group,4 cases replapsed because of graft oc- clusion at 12 months after procedure and then underwent amputation. During the follow-up period, graft ocelustion without recurrent symptom was observed in 10 patients. Overall limb salvage rate, effective rate and secondary graft pateney rate was 95. 6%, 84. 6%, 84. 6%, respectively. Conclusion When patients with CLI cannot be treated by any conventional treatment and require amputate,venous arterialization may be considered as unconventionality aher- native to save limbs if indiveation was selected carefully and procedure was operated standardly.