Frisch N, Bour P, Berg P, Fiévé G, Frisch R
Service de Chirurgie Générale et Vasculaire, Hôpital Central, Nancy, France.
Ann Vasc Surg. 1991 Jan;5(1):16-20. doi: 10.1007/BF02021771.
Sixty-two first episodes of aortofemoral (eight patients) or aortobifemoral (42 patients) bypass thrombosis were operated upon in 50 patients between 1980 and 1985. There were 47 men and three women whose mean age was 58 years. Retrograde thrombectomy through the distal anastomosis was achieved in all cases by using either a balloon catheter or Vollmar rings. If thrombectomy was impossible, revascularization was ensured by an extraanatomic bypass or complete replacement of the graft. Angioplasty, repeat distal anastomosis or femoropopliteal bypass of the native runoff artery were done in 55 (89%) operations. The cause of thrombosis was elucidated in 45 cases. Suture line stenosis and atheromatous stenosis of the native runoff artery were the two most common causes. Three patients died and two required above-knee amputation in the immediate postoperative period. Contralateral embolism occurred in two patients undergoing retrograde thrombectomy. Mean follow-up was 47 months. Thrombectomy was possible in 51 or 62 prosthetic thromboses (Group I). Thirty-nine of these grafts have remained patent. Twelve instances of repeat thrombosis occurred, requiring either repeat thrombectomy or a new bypass. Primary patency in group I was 97.8%, 81.2%, and 71.3% at one, three, and five years, respectively. Thrombectomy was impossible in 11 graft thromboses (Group II). A new bypass was performed in all 11 cases. Primary patency in Group II was 100%, 75% and 50% at one, three, and five years, respectively. Retrograde thrombectomy combined with treatment of native runoff artery anomalies can restore long-term patency when thrombosis occurs late after aortofemoral bypass and is associated with low mortality and morbidity.
1980年至1985年间，50例患者接受了62次首次主动脉股动脉（8例患者）或主动脉双股动脉（42例患者）搭桥血栓切除术。其中男性47例，女性3例，平均年龄58岁。所有病例均通过使用球囊导管或Vollmar环经远端吻合口进行逆行血栓切除术。如果无法进行血栓切除术，则通过解剖外搭桥或完全更换移植物来确保血运重建。55例（89%）手术进行了血管成形术、重复远端吻合或对原流出动脉进行股腘动脉搭桥。45例患者明确了血栓形成的原因。缝线处狭窄和原流出动脉粥样硬化狭窄是两个最常见的原因。3例患者死亡，2例在术后早期需要进行膝上截肢。2例接受逆行血栓切除术的患者发生了对侧栓塞。平均随访时间为47个月。51例（62例人工血管血栓形成中的）人工血管血栓切除术是可行的（第一组）。其中39根移植物保持通畅。发生了12例重复血栓形成，需要再次进行血栓切除术或进行新的搭桥手术。第一组在1年、3年和5年时的一期通畅率分别为97.8%、81.2%和71.3%。11例人工血管血栓形成无法进行血栓切除术（第二组）。所有11例均进行了新的搭桥手术。第二组在1年、3年和5年时的一期通畅率分别为100%、75%和50%。当主动脉股动脉搭桥术后晚期发生血栓形成并伴有较低的死亡率和发病率时，逆行血栓切除术联合对原流出动脉异常的治疗可恢复长期通畅。
