复合移植物股-远端动脉旁路术(附8例报道)

Below-the-knee Arterial Bypass by Composite Graft

目的：初步报道和评价复合材料移植物行膝下动脉旁路术挽救缺血肢体的结果。方法：８例缺乏合适自体静脉的病人应用复合移植物行膝下动脉旁路术，复合移植物近侧段为人造血管（ＰＴＦＥ），远侧段为自体静脉，自体静脉跨越膝关节，术后应用节段性动脉压测定（踝／肱指数）、双功彩超和动脉ＤＳＡ检查进行随访。结果：所有病人术后症状明显改善，静息痛消失，平均踝肱指数由术前的０．２１提高到０．６７，术后平均随访时间约１年，随访期间双功彩超和动脉造影检查显示移植物通畅，１例病人术后２个月因移植物血栓形成，经再次手术后症状缓解。结论：当肢体面临严重缺血需行膝下动脉旁路术而又缺乏可供移植的自体静脉时，复合移植物旁路术提供了一种有效的方法。

Objective: To evaluate the early results of composite grafts as below-the-knee bypasses. Methods: Eight patients underwent below-the-knee arterial revascularization with composite grafts on condition that autogenous vein grafts were not available. The composite grafts comprised of a proximal PTFE segment combined to a distal autogenous vein segment, crossing the knee joint. The patients were followedupbymeasuringankle-brachial systolic pressure index, Duplex scanning and arteriography post-operatively. Results: The symptoms were released dramatically, rest pain disappeared. The mean ankle-brachial systolic pressure index was 0.21 prior to operation and 0.67 after the operation. The patency of the composite grafts was proved by Duplex scanning and arteriography after an average of 1 year, except in one patient whose graft was thrombosed 2 months after operation, but relieved by a successful thrombectomy. Conclusions: Composite graft bypasses below-the-knee might serve as an alternative when autogenous vein grafts were not available.