Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
J Vasc Surg. 2011 Oct;54(4):1205-7. doi: 10.1016/j.jvs.2011.05.051. Epub 2011 Jul 29.
The endoluminal femoropopliteal bypass is a minimally invasive treatment modality for occlusive superficial femoral artery disease. Technical failure of endovascular treatment of chronic total occlusions is often caused by the inability to re-enter the true lumen. Re-entry devices have a high technical success-rate, but increased procedural costs. We describe an alternative technique using an ipsilateral combined antegrade-retrograde approach to insert an endoluminal femoropopliteal bypass. In a supine position, with the leg elevated at 30 degrees, the popliteal artery is punctured and a 4F introducer sheath is introduced. The occlusion is crossed from distal to proximal and the wire is advanced through a 6F sheath that is positioned in the common femoral artery. The occlusion is predilated from proximal and the "re-entry" site is identified on an angiogram. The wire is then withdrawn into the balloon catheter and advanced intraluminally into one of the crural vessels. After confirming the intraluminal position of the wire, the 4F sheath is removed, and the endoluminal bypass is created in a standardized fashion. The ipsilateral antegrade-retrograde approach is a fast, inexpensive, and easy-to-learn technique, using standard materials only. The distal entry of the occlusion will lead to a minimization of the length of the endoluminal bypass, thereby possibly sparing collaterals and future surgical options.
腔内股腘旁路术是治疗闭塞性股浅动脉疾病的一种微创治疗方法。慢性完全闭塞血管腔内治疗的技术失败通常是由于无法重新进入真腔。再进入装置具有较高的技术成功率，但增加了手术成本。我们描述了一种替代技术，即使用同侧顺行-逆行联合入路插入腔内股腘旁路。患者取仰卧位，腿抬高 30 度，穿刺腘动脉，引入 4F 导入鞘。从远端到近端穿过闭塞部位，将导丝推进置于股总动脉内的 6F 鞘管。从近端预扩张闭塞部位，并在血管造影上识别“再进入”部位。然后将导丝拉回球囊导管内，并向其中一条小腿血管腔内推进。确认导丝的腔内位置后，取出 4F 鞘管，以标准化的方式创建腔内旁路。同侧顺行-逆行入路是一种快速、廉价且易于学习的技术，仅使用标准材料。闭塞部位的远端进入将使腔内旁路的长度最小化，从而可能保留侧支循环和未来的手术选择。
