Muresan Mircea, Jimborean Ovidiu, Jimborean Gabriela, Neagoe Radu, Bancu Serban, Muresan Simona, Borz Cristian
Ann Ital Chir. 2017;6:433-437.
In vascular surgery the crossover iliofemoral bypass grafting is a well-known surgical technique. In general surgery the repair of an abdominal defect using a Polypropylene mesh is also a standard procedure. A particular technique is defined by the performance of these 2 separate procedures inside a single operation in which the crossover arterial graft is directed from the retroperitoneal space toward the contra-lateral femoral bifurcation through a Polypropylene mesh which closes the musculoaponeurotic layers of the abdominal wall. We present our experience with the use of this particular surgical technique in patients with critical limb ischemia and with indication for extra-anatomic crossover bypass (high-risk patients with contra-indication for the transperitoneal approach, extensive calcified aortic or iliac wall which contraindicated the direct arterial reconstruction or secondary arterial reconstruction after the occlusion of an aorto- femoral graft).
In principle, the hernioplasty was performed by using the Lichtenstein tension-free hernia repair technique, followed by the crossover iliofemoral bypass. The main feature of this technique is to pass the vascular graft from the retroperitoneal space above the mesh through a calibrated hole in the mesh RESULTS: The 7 patients with inguinal hernia and l limb-threatening ischemia had favorable evolution, without hernia recurrence, limb-threatening ischemia or any graft complication at 3 years.
Using this particular surgical technique we treated 2 surgical diseases using a single intervention for highrisk patients who had both inguinal hernia and contra-lateral critical limb ischemia. Being encouraged by the initial satisfactory results, we extended this technique even for the patients with indication of crossover iliofemoral bypass but without inguinal hernia.
The particular surgical technique of the crossover bypass in which the vascular graft crosses a tension-free Polypropylene mesh from the retroperitoneal space toward the Retzius space represents an efficient and short procedure which treats simultaneously 2 different surgical diseases (inguinal hernia and contra-lateral critical limb ischemia) in high-risk patients. The results were satisfactory: we had no hernia recurrence and the limb-threatening ischemia was successfully treated. The preferred vascular graft for this particular technique is the reversed autogenous vein because its resistance to infections and the vein long-term patency is better than of a vascular prosthesis. When a prosthetic graft is required, we prefer to use the classic technique in which the crossover graft is placed in an under-aponeurosis site, in order to diminish the prosthesis infection risk.
Abdominal wall, Iliofemoral bypass, Vascular surgery.
在血管外科中，交叉髂股旁路移植术是一种广为人知的手术技术。在普通外科中，使用聚丙烯网片修复腹壁缺损也是一种标准手术。一种特殊技术是在一次手术中同时进行这两种独立手术，其中交叉动脉移植物通过封闭腹壁肌肉腱膜层的聚丙烯网片从腹膜后间隙引向对侧股动脉分叉处。我们介绍了在严重肢体缺血患者以及有解剖外交叉旁路指征（经腹途径有禁忌的高危患者、广泛钙化的主动脉或髂动脉壁，禁忌直接动脉重建或主动脉-股动脉移植物闭塞后的二次动脉重建）的患者中使用这种特殊手术技术的经验。
原则上，疝修补术采用利希滕斯坦无张力疝修补技术，随后进行交叉髂股旁路移植术。该技术的主要特点是使血管移植物从网片上方的腹膜后间隙穿过网片上的校准孔。
7例腹股沟疝合并肢体威胁性缺血患者病情进展良好，3年时无疝复发、肢体威胁性缺血或任何移植物并发症。
我们使用这种特殊手术技术，通过一次干预治疗了同时患有腹股沟疝和对侧严重肢体缺血的高危患者的两种外科疾病。鉴于初步的满意结果，我们甚至将该技术扩展应用于有交叉髂股旁路指征但无腹股沟疝的患者。
交叉旁路的这种特殊手术技术，即血管移植物从腹膜后间隙穿过无张力聚丙烯网片进入耻骨后间隙，是一种高效且简短的手术，可同时治疗高危患者的两种不同外科疾病（腹股沟疝和对侧严重肢体缺血）。结果令人满意：无疝复发，肢体威胁性缺血得到成功治疗。这种特殊技术首选的血管移植物是自体静脉反转，因为其抗感染能力以及静脉长期通畅性优于血管假体。当需要使用人工移植物时，我们更倾向于使用经典技术，即将交叉移植物置于腱膜下部位，以降低假体感染风险。
腹壁；髂股旁路；血管外科
