Nicholson M L, Beard J D, Horrocks M
Department of Vascular Surgery, Bristol Royal Infirmary, UK.
Br J Surg. 1988 Nov;75(11):1064-6. doi: 10.1002/bjs.1800751106.
Although femorofemoral bypass grafting was originally used only as a method of limb salvage, it is now used increasingly in patients with claudication. If this trend is to be supported, the haemodynamic consequences of the operation must be carefully assessed. Fifteen patients undergoing femorofemoral grafting were studied prospectively by intra-operative measurement of the inflow resistance (IR) of the donor iliac segment. Three groups were identified by this technique. Patients with an IR less than 0.05 (n = 8) were uncomplicated; those with an IR greater than or equal to 0.05 but less than 0.10 (n = 5) developed a subclinical steal syndrome; and those with an IR greater than 0.10 (n = 2) developed a clinical steal syndrome. High initial IR values were corrected at the time of surgery in two cases. This study demonstrates that steal syndromes can occur after femorofemoral grafting and that the cause is an unmasking of previously unrecognized disease in the donor arterial segment. The measurement of IR allows the prediction of steal syndromes and their correction at the time of surgery. Direct haemodynamic studies are recommended, especially as the availability of balloon angioplasty has made inflow disease amenable to treatment.
尽管股-股动脉搭桥术最初仅用作挽救肢体的一种方法，但现在越来越多地用于治疗间歇性跛行患者。若要支持这一趋势，必须仔细评估该手术的血流动力学后果。通过术中测量供体髂动脉段的流入阻力（IR），对15例行股-股动脉移植术的患者进行了前瞻性研究。通过该技术确定了三组。IR小于0.05的患者（n = 8）无并发症；IR大于或等于0.05但小于0.10的患者（n = 5）出现亚临床窃血综合征；IR大于0.10的患者（n = 2）出现临床窃血综合征。2例患者在手术时纠正了较高的初始IR值。本研究表明，股-股动脉移植术后可发生窃血综合征，其原因是供体动脉段先前未被识别的疾病被暴露。IR的测量可预测窃血综合征并在手术时进行纠正。建议进行直接血流动力学研究，尤其是因为球囊血管成形术的应用使流入道疾病易于治疗。
