Cardia Giuseppe, Cianci Valentina, Merlicco Domenico
Unità Operativa Semplice di Chirurgia Vascolare, Dipartimento per le Applicazioni in Chirurgia delle Tecnologie Innovative, Università degli Studi di Bari.
Chir Ital. 2002 Jul-Aug;54(4):487-93.
Femoral bifurcation reoperation is a stern test for skilfull surgeons, owing to the presence of thick scar tissue from the previous operations, especially when prosthetic grafts are used. In cases of aorto-femoral graft thrombosis, if thrombectomy of the entire graft is possible, one could isolate the anastomotic tract with all the afferent vessels and construct a new anastomosis downstream in tissue which allows a better run-off. Often in our experience we executed a by-pass, with a vein or short tract of new graft, from the previous prosthetic branch to a distal part of the deep femoral artery. In this way the reoperation is faster and safer, limiting dangerous dissection times. In infected inguinal pseudo-aneurysms we prefer an axillo-femoral by-pass, with isolation of the deep femoral artery by lateral incision, outside the infected field. In the non-infected ones, the reconstruction involves the use of a new small-sized graft between the previous structures. In cases of femoro-femoral occlusion we think it is better, first of all, to evaluate the possibility of an orthotopic graft from the aorta or iliac artery.
股动脉分叉再次手术对技术娴熟的外科医生来说是一项严峻的考验，因为之前手术会留下厚厚的瘢痕组织，尤其是在使用人工血管移植物的情况下。在主-股动脉移植血管血栓形成的病例中，如果能够对整个移植血管进行血栓清除术，可以分离出吻合口以及所有传入血管，并在能提供更好血流的组织下游构建新的吻合口。根据我们的经验，通常会采用静脉或新的短段移植物进行搭桥，从先前的人工血管分支连接到股深动脉的远端部分。这样一来，再次手术更快、更安全，减少了危险的解剖时间。对于感染性腹股沟假性动脉瘤，我们更倾向于采用腋-股动脉搭桥术，通过外侧切口在感染区域外分离股深动脉。对于非感染性的，重建需要在先前结构之间使用新的小口径移植物。在股-股动脉闭塞的病例中，我们认为首先最好评估从主动脉或髂动脉进行原位移植的可能性。
