Shindo S, Saka A, Kubota K, Kojima A, Ishimoto T, Iyori K, Kobayashi M, Kamiya K, Tada Y
Second Department of Surgery, Yamanashi Medical University, Japan.
Surg Today. 2001;31(8):754-8. doi: 10.1007/s005950170087.
An aggressive approach to vascular reconstruction should be adopted in patients with Buerger's disease and peripheral ischemia who are often young and otherwise active. A patient with severe Buerger's disease is reported who was treated successfully by complete vascular reconstruction with staged bypass surgery while also performing repeated angiography to preserve the foot function. A 48-year-old man with Buerger's disease presented with necrosis of the foot. Angiography showed occlusion of the right distal external iliac artery and no runoff below the knee. Repeated angiography after performing a lumbar sympathectomy demonstrated patency of the distal portion of the deep femoral artery. Angiography was again performed after a reconstruction of the deep femoral artery and patency of the anterior tibial artery was observed. A staged bypass operation on the tibial artery was therefore able to achieve a prompt healing of both the toe ulcers and plantar wound.
对于患有血栓闭塞性脉管炎且常为年轻且其他方面活跃的外周缺血患者，应采取积极的血管重建方法。本文报道了一名重症血栓闭塞性脉管炎患者，通过分期搭桥手术进行完全血管重建，并同时反复进行血管造影以保留足部功能，最终获得成功治疗。一名48岁的血栓闭塞性脉管炎男性患者出现足部坏死。血管造影显示右髂外动脉远端闭塞，膝以下无血流。在进行腰交感神经切除术后反复血管造影显示股深动脉远端通畅。在股深动脉重建后再次进行血管造影，观察到胫前动脉通畅。因此，对胫动脉进行分期搭桥手术能够使趾溃疡和足底伤口迅速愈合。
