自体静脉旁路移植术治疗下肢动脉硬化闭塞症疗效分析

Autogenous vein bypass grafts for the treatment of lower limb arteriosclerosis obliterans

关键词:  动脉硬化闭塞  自体静脉  旁路术

Key words:  [Key words]　arteriosclerosis obliterans  autogenous vein  bypass grafts

摘要:

目的　探讨自体静脉旁路移植术在治疗下肢动脉硬化闭塞症中的作用。　方法　　回顾性分析2004年1月—2012年7月应用自体静脉旁路移植术治疗的35例伴重症下肢缺血的下肢动脉硬化闭塞症患者的临床资料。所有病例均表现为下肢静息痛和/或溃疡、坏死，术前血管造影显示下肢动脉节段性闭塞为TASC C或D级病变。下肢血流重建采用以自体大隐静脉为移植物的动脉旁路手术。　结果　　35例中34例（97.1%）术后患肢静息痛消失，皮肤温度、颜色明显改善，踝肱指数均值由术前0.11±0.13升为术后0.91±0.23，两者之间差异有显著性意义（P<0.001）。术后随访30例，随访时间1~5年（平均3.5年），术后1、3、5年移植血管的一期累计通畅率分别为91%、80%、75%，二期累计通畅率分别为95%、83%、77%。 　结论　　自体静脉旁路移植术是治疗动脉硬化性重症下肢缺血，挽救患者肢体的有效方法。

Abstract:

[Abstract] Objective　To assess the clinical effects of autogenous vein bypass grafts for the treatment of lower limb arteriosclerosis obliterans. 　Methods We retrospectively analyzed 35 patients of lower limb arteriosclerosis obliterans with critical lower limb ischemia, for which autogenous vein bypass grafts were performed from January 2004 to August 2012. Clinical manifestations in these patients were resting pain and/or ulcer/necrosis of the lower limb, in which preoperative angiography showed segmental TASC C, D occlusive lesions. Blood stream of the lower limb was reconstructed by bypass surgery using autogenous saphenous vein grafts. 　Results In 34 cases (97.1%) symptoms were relieved, with resting pain disappeared and skin temperature improved. Ankle brachial index (ABI) increased significantly from 0.11±0.13 to 0.91±0.23 perioperatively (P<0.001). Postoperatively, 30 cases were followed up for 1 year to 5 years. The primary graft patency rates in this series were 91%, 80% and 75% in 1 year, 3 years and 5 years, respectively. The secondary graft patency rates were 95%, 83% and 77% in 1 year, 3 years and 5 years, respectively. 　Conclusion Autogenous vein bypass graft is an effective method for the treatment of lower extremity ischemia due to arteriosclerosis obliterans and the salvage of the limbs.