| 摘要: |
| ［摘要］ 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500 m。深组4例患者在术后1年出现移植物闭塞，行截肢术。随访期间，10例患者彩超检查出现移植物闭塞，但无临床症状。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。 |
| 关键词: 下肢严重缺血 血栓闭塞性脉管炎 动脉硬化闭塞症 静脉动脉化 |
| DOI：10.3969/j.issn.1674-3806.2013.10.19 |
| 分类号:R 543 |
| 基金项目: |
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| Venous arterialization for treating lower limbs ischemia |
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TONG Xian-zhou, TONG Lin-long,CHEN Tao
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Department of Vasular Surgery,Zhengzhou People′s Hospital,Henan 450003,China
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| Abstract: |
| ［Abstract］ Objective To assess the clinical effectiveness of venous arterialization in the treatment of patients with critical limb ischemia（CLI）.Methods From January 2000 to December 2011,91 patients with CLI,including 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 arterial occlusion,3 kinds of venous arterialization were performed: high deep venous arterialization group（n=30）:reversal produced between the common or superficial femoral artery and superficial vein;low deep venous arterialization group（n=32）:reversal produced the popliteal artery and the tibiaperoneal venous trunk;superficial venous arterialization group（n=29）:reversal produced between the femoral or popliteal artery and the distal potion of the long saphenous 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 claudication or claudication distance >500 meters.In high deep venous arterializations group,4 cases replapsed because of graft occlusion at 12 months after procedure and then underwent amputation. During the follow-up period,graft occlustion without recurrent symptom was observed in 10 patients. Overall limb salvage rate,effective rate and secondary graft patency 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 alternative to save limbs if indivcation was selected carefully and procedure was operated standardly. |
| Key words: Critical limb ischemia(CLI) Thromboangiitis obliterans(TAO) Artherosclerosis obliterans(ASO) Venous arterialization |
