原位大隐静脉旁路移植术治疗下肢缺血34例

The in situ great saphenous vein bypass for the treatment of lower limb ischemia

目的 探讨原位大隐静脉旁路移植术治疗下肢缺血的疗效。方法用自制的静脉瓣膜刀为 34例患者行原位大隐静脉旁路移植术 ,其中 3例做膝上动脉吻合 ,16例行膝下动脉吻合 ,11例行胫后动脉吻合 ,4例行胫前动脉吻合。结果 2 6例出院时静息痛消失 ,7例患者间歇跛行消失 ,平均踝 /肱比由术前的 0 34(0～ 0 5 2 )提高到 0 78(0 4 8～ 1 2 )。本组 6、12、2 4、36、4 8个月的通畅率分别为 91 18%、88 14 %、84 99%、80 5 2 %、80 5 2 %。结论原位大隐静脉旁路移植术能有效地改善或消除肢体缺血 ,自制静脉瓣膜刀能有效破坏大隐静脉的瓣膜 。

ObjectiveTo evaluate the result of in situ great saphenouse vein bypass for the treatment of lower limb ischemia.MethodsFrom 1995 to 2000, 34 patients with femoro popliteal artery occlusive disease underwent in situ great saphenouse vein bypass using self made valvulotome in our hospital.The distal anastomosis was made on above knee popliteal artery in 3 cases, below knee popliteal artery in 16 cases, posterior tibial artery in 11 cases and anterior tibial artery in 4 cases, respectively.ResultsOn discharge, the rest pain disappeared in 26 cases and intermittent claudication disappeared in 7 cases, with average ankle/brachial index changing from 0 34(0～0 52) preoperatively to 0 78(0 48～1 2) postoperatively.The cumulative patency rate at 6,12,24,36 and 48 monthes were 91 18%?88 14%?84 99%?80 52%?80 52%,respectively.ConclusionIn situ great saphenouse vein bypass is effective for the treatment of lower limb arterial ischemia. The vein valve was disrupted successfully with self made valvulotome.