下肢动脉硬化闭塞症腔内治疗失败后行旁路手术血运重建的临床疗效分析

Predictive value of plasma HDL-C level for risk of pulmonary hypertension in patients with chronic obstructive pulmonary disease

关键词:  下肢动脉硬化闭塞症  下肢动脉旁路术  腔内治疗  血流重建

Key words:  lower limb arteriosclerosis obliterans  lower limb arterial bypass surgery  endovascular therapy  revascularization

摘要:

目的评估血管腔内治疗失败后行下肢动脉旁路手术的治疗效果。 方法回顾性分析中国人民解放军海军军医大学第二附属医院血管外科2017年6月—2022年6月血管腔内治疗失败后行下肢动脉旁路术的11例下肢动脉硬化闭塞症患者资料。入选患者均在初始经历1次或多次的腔内治疗后下肢动脉再次闭塞，腔内治疗无法有效再通血管需要行下肢动脉旁路术。根据患者症状及病变进行Rutherford分级和TASCⅡ分级，对患者的年龄、性别、高危因素、既往腔内治疗次数、治疗方式、吻合口位置、搭桥方式、桥血管通畅率等并进行统计分析。 结果11例患者因腔内治疗失败后行开放血管旁路手术重建血流。其中下肢人工血管旁路术10例，下肢人工血管+自体大隐静脉旁路术1例。手术时间150~250min，平均手术时间（199±30.29）min，围手术期出现1例淋巴瘤、1例切口感染。术后随访12~25个月，6个月桥血管通畅率81.8%，12个月桥血管通畅率63.3%。 结论对于病变合适的下肢动脉硬化闭塞症患者，腔内治疗失败后开放旁路手术可以作为下肢动脉闭塞的血运重建方式，但腔内治疗后血管造成损伤以及患者基础情况不佳，其桥血管通畅率可能相对较差，具体技术方式及随访结果仍有待于进一步的临床研究。

Abstract:

ObjectiveTo evaluate the efficacy of bypass surgery after failed endovascular treatment for arteriosclerosis obliterans of lower extremities. MethodsClinical data of 11 patients with arteriosclerosis obliterans of lower extremities who underwent lower limb artery bypass surgery after failed endovascular treatment at our center from 2017 to 2022 were retrospectively analyzed. Patients all experienced lower limb artery re-occlusion after one or more endovascular treatments, and lower limb artery bypass surgery was required to restore blood vessels. Rutherford staging and TASC Ⅱ grading were performed based on patient’s symptoms and lesions. The age, gender, high-risk factors, number and method of previous endovascular treatments, anastomotic site location, bypass method, and bridge vessel patency rate of patients were analyzed. ResultsAmong 11 patients, the lower limb artificial vessel bypass surgery was performed in 10 cases and lower limb artificial vessel+autologous great saphenous vein bypass surgery was performed in one case. The mean surgical time was 199±3029min(150-250min). One case of lymphoma and one case of incision infection occurred during the perioperative period. Postoperative follow-up was 12-25months, with a bridge vessel patency rate of 81.8% at 6 months and 63.3% at 12 months. ConclusionFor patients with arteriosclerosis obliterans of lower extremities, open bypass surgery after failed endovascular treatment can be used as a blood flow reconstruction method. However, the damage to blood vessels caused by endovascular treatment and the poor basic condition of patients may result in relatively poor bridge vessel patency.