桥式血管转流移植治疗下肢严重缺血性疾病

Revascularization in severe ischemic diseases of lower extremities

目的 :探讨人体下肢动脉狭窄和闭塞性疾病的外科治疗方法。方法 :本组 7例中 3例为血栓闭塞性脉管炎 ,4例为闭塞性动脉硬化。 7例均采用经皮动脉穿刺插管行腹主动脉、双下肢动脉造影 ,明确动脉闭塞的具体部位及其长度 ,选择合适的手术方式。结果 :3例血栓闭塞性脉管炎患者 ,分别行股浅静脉动脉化及胫腓干静脉动脉化 ;4例闭塞性动脉硬化患者 ,分别行右腋动脉 -股动脉间旁路搭桥、髂外动脉 -股深动脉间旁路搭桥、髂总 -股深、股深 -月国动脉间旁路搭桥。经随访 ,7例患者术后至今状况良好。结论 :下肢闭塞性动脉硬化大多为节段性 ,股深动脉大多通畅 ,故手术以动脉旁路搭桥转流较为合适。如闭塞范围广 ,包括血栓闭塞性脉管炎 ,手术则以静脉动脉化或其他适当的治疗方法为宜。

Objective:To evaluate the approach of surgical treatment for arteriostenosis and arterial occlusion of the lower extremities. Methods:There were 7 patients in this series. Three had thromboangiitis obliterans and 4 had arteriosclerosis obliterans. In order to make sure the exact location and length of the arterial occlusion and chose the right operative method, abdominal aortography and lower limb aortography were performed by the percutaneous arteriopuncture and arterial catheter in all patients. Results:Superficial femoral venous arterialization and tibial and peronal venous arterialization were performed in 3 patients with thromboangiitis obliterans, respectively. Right axillary femoral artery, common iliac deep femoral artery and deep femoral popliteal artery bypasses were performed in 4 patients with arteriosclerosis obliterans. All patients recovered. Conclusion:Most of arteriosclerosis obliterans in lower extremities are segmental. Usually the deep femoral artery is unobstructed, so it is more suitable for the arterial bypass operation. If the arteries are occluded (including Buerger’s disease) or obstructed extensively, it is better to make the veins arterialize or utilize other proper therapies.