Flørenes Tor, Sandbaek Gunnar, Stranden Einar, Jørgensen Jørgen J
Oslo vaskulaere senter, Oslo universitetssykehus, Aker, 0514 Oslo, Norway.
Tidsskr Nor Laegeforen. 2009 Nov 5;129(21):2252-5. doi: 10.4045/tidsskr.09.0181.
Walking exercise, smoking cessation and best medical therapy are cornerstones in all treatment of atherosclerosis. For patients with intermittent claudication or critical limb ischemia, endovascular therapy (which has developed substantially during the last decade) has become the first line treatment (when feasible). The aim of this article is to provide an overview of options for surgical treatment of peripheral atherosclerosis in the lower limbs.
The article is based on literature identified through a non-systematic search in PubMed, vascular textbooks and the authors' own clinical experience.
When endovascular therapy has failed or is not feasible, open surgical techniques are used, such as endarterectomy and bypass surgery to the popliteal or distal arteries. Hybrid procedures, with femoral endarterectomy and distal or proximal endovascular intervention, are often used. Increased use of endovascular treatment reduces the procedural time, length of hospital stay and the rate of complications. In patients with extreme disease progression, primary amputation may still be the treatment of choice.
Surgical treatment of peripheral artery disease requires competence both within radiological intervention and open surgical treatment modalities.
步行锻炼、戒烟和最佳药物治疗是动脉粥样硬化所有治疗方法的基石。对于间歇性跛行或严重肢体缺血的患者，血管内治疗（在过去十年中已得到很大发展）已成为一线治疗方法（在可行的情况下）。本文旨在概述下肢周围动脉粥样硬化的手术治疗选择。
本文基于通过在PubMed上进行非系统检索、血管教科书以及作者自身临床经验所确定的文献。
当血管内治疗失败或不可行时，可采用开放手术技术，如动脉内膜切除术以及腘动脉或远端动脉的搭桥手术。常采用股动脉内膜切除术与远端或近端血管内介入相结合的杂交手术。血管内治疗使用的增加减少了手术时间、住院时间和并发症发生率。在疾病进展极为严重的患者中，一期截肢可能仍是首选治疗方法。
外周动脉疾病的手术治疗需要具备放射介入和开放手术治疗方式两方面的能力。
