Lu Feng, Zhang Hao, Shi Ya-Xue, Zhang Ji-Wei, Zhang Bai-Gen
Department of Vascular Surgery, Renji Hospital, Medical College of Shanghai Jiao Tong University, Shanghai 200001, China.
Zhonghua Wai Ke Za Zhi. 2009 Aug 1;47(15):1175-8.
To review the follow-up results of the crural artery bypass.
Sixty-five limbs in 64 patients with long stenosis or occlusion in femoral artery and popliteal artery were performed 65 times femoral-crural artery bypass surgery or femoral-popliteal-crural bypass surgery during April 2001 to July 2007. The ankle-brachial index before bypass surgery was 0.35 +/- 0.20 in anterior tibial artery and 0.38 +/- 0.21 in posterior tibial artery. Critical limb ischemia was 93.8%.
The ankle-brachial index after bypass surgery was 0.84 +/- 0.26 in anterior tibial artery and 0.83 +/- 0.22 in posterior tibial artery. The perioperative mortality rate was 1.6%, the perioperative amputation rate was 1.5%. Fifty-four patients 54 limbs were followed up. The average follow-up time was (24.1 +/- 16.6) months. The follow-up limb salvage rate was 85.2%. The follow-up mortality rate was 25.9%. Critical limb ischemia decreased as 13.0%. The follow-up ankle-brachial index was difference with before and after bypass surgery as 0.66 +/- 0.26 in anterior tibial artery and 0.64 +/- 0.25 in posterior tibial artery. It was no difference in cumulative limb salvage rate, cumulative primary and secondary patency rate by comparing autogenous vein with composite vascular as graft and comparing femoral-crural artery bypass surgery with femoral-popliteal-crural bypass surgery as surgical method.
When the patients are failed in endovascular intervention or have long stenosis or occlusion in femoral artery and popliteal artery to face to amputation, the crural artery bypass is a feasible method. It's helpful to improve the secondary patency rate and limb salvage rate by enhancing the follow-up after operation and early intervention.
回顾小腿动脉搭桥术的随访结果。
2001年4月至2007年7月期间，对64例股动脉和腘动脉存在长段狭窄或闭塞的患者的65条肢体进行了65次股-小腿动脉搭桥术或股-腘-小腿搭桥术。搭桥术前胫前动脉的踝肱指数为0.35±0.20，胫后动脉为0.38±0.21。严重肢体缺血占93.8%。
搭桥术后胫前动脉的踝肱指数为0.84±0.26，胫后动脉为0.83±0.22。围手术期死亡率为1.6%，围手术期截肢率为1.5%。对54例患者的54条肢体进行了随访。平均随访时间为(24.1±16.6)个月。随访肢体挽救率为85.2%。随访死亡率为25.9%。严重肢体缺血降至13.0%。随访时胫前动脉的踝肱指数为0.66±0.26，胫后动脉为0.64±0.25，与搭桥术前、后有差异。自体静脉与复合血管作为移植物，以及股-小腿动脉搭桥术与股-腘-小腿搭桥术作为手术方式比较，累积肢体挽救率、累积一期和二期通畅率无差异。
当患者血管腔内介入治疗失败或股动脉和腘动脉存在长段狭窄或闭塞面临截肢时，小腿动脉搭桥术是一种可行的方法。加强术后随访及早期干预有助于提高二期通畅率和肢体挽救率。
