Myhre H O, Saether O D
Department of Surgery, Trondheim University Hospital, Norway.
Acta Chir Scand Suppl. 1987;538:31-5.
Early postoperative problems following aorto-ilio-femoral thrombendarterectomy include occlusion, bleeding and emboli. Technical details important for the prevention of these complications are discussed. Late problems include reobstruction, sexual dysfunction and aneurysm formation, the last complication being unusual following thrombendarterectomy. Late reobstruction is usually caused by progression of atherosclerosis and technical failures. Bypass grafting using synthetic material is usually the preferred method in redo aorto-ilio-femoral reconstruction since extensive dissection of the arteries is then avoided. We prefer a regular laparotomy for these operations. It might be an advantage to introduce ureteral stents making it easier to identify the ureter which may be surrounded by scar tissue following previous dissection. The creation of sufficient run-off is important. In several cases the procedure must therefore be supplemented with a profunda artery reconstruction. In case of localized and moderate obstruction PTA may be indicated for the relief of recurrent arterial obstruction following thrombendarterectomy.
主动脉-髂股动脉血栓内膜切除术后的早期问题包括血管闭塞、出血和栓子。本文讨论了预防这些并发症的重要技术细节。晚期问题包括再阻塞、性功能障碍和动脉瘤形成，最后一种并发症在血栓内膜切除术后并不常见。晚期再阻塞通常由动脉粥样硬化进展和技术失误引起。在再次进行主动脉-髂股动脉重建时，使用合成材料进行旁路移植通常是首选方法，因为这样可以避免对动脉进行广泛的解剖。我们更倾向于通过常规剖腹手术进行这些操作。放置输尿管支架可能具有优势，这样更容易识别输尿管，因为在先前的解剖后输尿管可能被瘢痕组织包围。建立足够的流出道很重要。因此，在一些病例中，该手术必须辅以股深动脉重建。对于局限性和中度阻塞的情况，经皮腔内血管成形术（PTA）可能适用于缓解血栓内膜切除术后复发性动脉阻塞。
