Al-Wahbi Abdullah
Department of Vascular Surgery, King Abdulaziz Medical City, Vascular Surgery Division, Riyadh, Saudi Arabia.
Local Reg Anesth. 2010;3:129-32. doi: 10.2147/LRA.S13928. Epub 2010 Oct 11.
For an active, ambulant patient with critical, lower limb ischemia, amputation can lead to a poor quality of life. A small group of older people with critical limb ischemia are considered at high risk for revascularization under conventional anesthesia owing to their comorbid conditions. In these cases, when endovascular therapy is not an option, the decision to amputate or revascularize presents a dilemma, especially in ambulant patients. In this article, we present 2 cases in which the individuals had diabetic foot gangrene, rest pain, and multiple comorbidities, and were unfit to undergo conventional anesthesia. In addition, they had severe aortoiliac occlusive disease, which cannot be managed by endovascular methods. Both patients were living independently and were ambulant before their foot ulcer and ischemia. They underwent an axillofemoral bypass under local anesthesia. The postoperative course was uneventful. After a 3-year follow-up, both patients continue to be ambulant and have no complaints. With selective use of local anesthetic techniques, surgical teamwork to shorten the procedure time, and close meticulous postoperative care, an axillofemoral bypass can enable limb salvage for ambulant patients who are considered unfit for conventional anesthesia.
对于患有严重下肢缺血的活动自如、可行走的患者而言，截肢会导致生活质量低下。一小部分患有严重肢体缺血的老年人，由于其合并症，被认为在传统麻醉下进行血管重建的风险很高。在这些情况下，当血管内治疗不可行时，截肢还是血管重建的决定就会带来两难困境，尤其是对于可行走的患者。在本文中，我们介绍了2例患有糖尿病足坏疽、静息痛和多种合并症且不适合接受传统麻醉的患者。此外，他们患有严重的主-髂动脉闭塞性疾病，无法通过血管内方法进行治疗。两名患者在足部溃疡和缺血之前均能独立生活且可行走。他们在局部麻醉下接受了腋-股动脉旁路移植术。术后过程顺利。经过3年的随访，两名患者仍可行走且无不适主诉。通过选择性地使用局部麻醉技术、缩短手术时间的手术团队协作以及精心细致的术后护理，腋-股动脉旁路移植术能够为那些被认为不适合传统麻醉的可行走患者保住肢体。
