Chapleau D, Lassonde J, Blair J F, Laurendeau F
Service de Chirurgie Vasculaire, Hôpital Maisonneuve-Rosemont, Montréal, Québec.
Ann Chir. 1991;45(9):751-5.
From January 1985 to december 1989, 83 patients (69 men, 14 women) underwent an in situ femoro-popliteal bypass using a semi-closed technique and the valvulotome developed by Dr Paul Cartier. Most patients (67%) were operated for severe ischemia while 33% were for claudication. HTA was present in 31% of patients, diabetes in 38% and CAD in 57%. Mean preoperative ABI was 0.33 +/- 0.20 and mean ankle pressure was 50 +/- 30 mm of Hg. Arteriographic popliteal run-off showed three vessels in 21 cases (25%), two vessels in 17 cases (20%) and one vessel in 38 cases (45%). Nine patients (10%) presented an isolated popliteal artery. Bypass was constructed below knee in 62 patients (73%) and above knee in 23 (27%). Five mortalities (5.8%) and two major complications (2.3%) were related to surgery. Four early graft failures (4.4%) were noted but 3 were successfully reoperated. Postoperative ABI was 0.71 +/- 0.23 mm of Hg and 81% of patients had complete relief of their symptoms. With a mean follow-up 19 months, graft patency was 91% +/- 6% and 84% +/- 11% at one and two years and was not influenced by operative indication: hypertension, diabetes, preoperative ABI, arteriographic findings or distal anastomotic site. Overall survival was 80% +/- 10% and 69 +/- 13 at one and two years. The in situ technique using the Cartier valvulotomes is an excellent operation and compares favourably with other techniques.
1985年1月至1989年12月，83例患者（69例男性，14例女性）采用半闭合技术及保罗·卡蒂埃医生研发的瓣膜刀进行原位股腘动脉搭桥术。大多数患者（67%）因严重缺血接受手术，33%因间歇性跛行接受手术。31%的患者患有高血压，38%患有糖尿病，57%患有冠心病。术前平均踝肱指数（ABI）为0.33±0.20，平均踝部压力为50±30毫米汞柱。动脉造影显示，腘动脉流出道有三支血管的有21例（25%），两支血管的有17例（20%），一支血管的有38例（45%）。9例患者（10%）存在孤立性腘动脉病变。62例患者（73%）在膝关节以下进行搭桥，23例（27%）在膝关节以上进行搭桥。5例死亡（5.8%）和2例严重并发症（2.3%）与手术相关。发现4例早期移植物失败（4.4%），但3例成功再次手术。术后ABI为0.71±0.23毫米汞柱，81%的患者症状完全缓解。平均随访19个月，1年和2年时移植物通畅率分别为91%±6%和84%±11%，且不受手术指征（高血压、糖尿病、术前ABI、动脉造影结果或远端吻合部位）的影响。1年和2年时总体生存率分别为80%±10%和69%±13%。使用卡蒂埃瓣膜刀的原位技术是一种出色的手术，与其他技术相比具有优势。
