Zatina M A, Schroder W B, Wilkerson D K, Tarantino D A
Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903-0019.
Ann Vasc Surg. 1991 Mar;5(2):143-9. doi: 10.1007/BF02016747.
Preoperative contrast arteriography is presently considered a requirement when planning infrainguinal arterial reconstructions in patients with limb-threatening ischemia. We reviewed the clinical data from 22 infrainguinal bypasses done in 20 patients to see if appropriate decisions concerning operability and the nature of the operation could be made from the physical examination and noninvasive data supplemented by a limited intraoperative on-table prebypass arteriogram. The presence of a normal femoral pulse with either a normal thigh pulse volume tracing or a normal high-thigh index assured adequate inflow to the groin level. The presence of an arterial Doppler signal at the ankle level, heard with a hand held Doppler, confirmed the presence of patent outflow vessels for the distal anastomosis. The exact site of the distal anastomosis could be determined with the on-table prebypass arteriogram. In patients with limb-threatening ischemia due to occlusive disease limited to the infrainguinal arterial tree, an appropriate operative bypass may be performed without the aid of the preoperative arteriogram.
目前，对于患有肢体威胁性缺血的患者，在规划腹股沟下动脉重建手术时，术前造影动脉造影被认为是一项必要检查。我们回顾了20例患者进行的22例腹股沟下旁路手术的临床资料，以确定是否可以通过体格检查、无创数据以及有限的术中旁路术前动脉造影来做出关于手术可行性和手术性质的恰当决策。股动脉搏动正常，同时大腿脉搏容积描记正常或高位大腿指数正常，可确保腹股沟水平有足够的血流流入。用手持多普勒听诊器在踝关节水平听到动脉多普勒信号，证实存在用于远端吻合的通畅流出血管。通过术中旁路术前动脉造影可以确定远端吻合的确切位置。对于因闭塞性疾病局限于腹股沟下动脉树而导致肢体威胁性缺血的患者，无需术前动脉造影即可进行合适的手术旁路。
