Gao J P, Li H, Zuo S W, Wu Y, Jia S H, Xiong J, Guo W
Department of Vascular Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100080, China.
Zhonghua Wai Ke Za Zhi. 2021 Dec 1;59(12):980-986. doi: 10.3760/cma.j.cn112139-20210903-00417.
To examine the effectiveness of revascularization of the deep femoral artery and its inflow vessels to treat critical limb ischemia in patients with thromboangiitis obliterans (TAO). The clinical data of 9 TAO patients with critical limb ischemia who underwent deep femoral artery and its inflow revascularization from January 2018 to October 2020 at Department of Vascular Surgery, the First Medical Center, People's Liberation Army General Hospital were retrospectively analyzed.There were all males, aged from 26 to 50 years with onset time from 1 to 7 years.All patients had severe rest pain, and 4 had ischemic ulcers or gangrene.All patients had occlusion of the deep femoral artery origins and(or) its inflow tracts, including 2 ipsilateral common iliac artery occlusion, 4 ipsilateral external iliac artery occlusion, 7 common femoral artery occlusion, and 8 deep femoral artery origins, without the involvement of the contralateral common femoral artery or its inflow tracts.Surgical procedures included femoral endarterectomy with thrombectomy, merge suture, and bypass.Technical success rate, rest pain relief, ulcer healing, patency, amputation rate, and long-term prognosis were recorded. The overall technical success rate was 9/9, including 8 femoral endarterectomies with thrombectomy (with 4 patch-angioplasty with the great saphenous vein, 1 merge suture, and 3 simple sutures), 4 femoral-femoral bypasses with artificial vessels, and 1 superficial femoral artery bypass with the great saphenous vein.Rest pain disappeared after the operation immediately.The follow-up time was 10 to 44 months.All patients survived.The semi-annual patency rate was 9/9, and the one-year patency rate was 6/8.Except for one patient with significantly reduced but unhealed dorsalis ulcer up to now due to continuous heavy tobacco exposure after surgery, all others had no rest pain occurred or recurrence of foot ulcers during the follow-up.Among the 8 patients, 3 cases with recent claudication had continuous moderate tobacco exposure (10 to 20 cigarettes per day or severe passive smoking). For patients with thromboangiitis obliterans involved in the deep femoral artery or its inflow vessels, revascularization should be the primary choice and a good long-term prognosis is promising.Postoperative tobacco exposure (including passive smoking) is of great impact on the prognosis of TAO patients, and smoking cessation education must be reemphasized and reinforced.
探讨股深动脉及其流入道血管重建术治疗血栓闭塞性脉管炎（TAO）患者严重肢体缺血的有效性。回顾性分析2018年1月至2020年10月在解放军总医院第一医学中心血管外科接受股深动脉及其流入道血管重建术的9例TAO严重肢体缺血患者的临床资料。患者均为男性，年龄26～50岁，发病时间1～7年。所有患者均有严重静息痛，4例有缺血性溃疡或坏疽。所有患者均存在股深动脉起始部和（或）其流入道闭塞，其中2例同侧髂总动脉闭塞，4例同侧髂外动脉闭塞，7例股总动脉闭塞，8例股深动脉起始部闭塞，对侧股总动脉及其流入道未受累。手术方式包括股动脉内膜剥脱取栓术、吻合缝合术和旁路移植术。记录技术成功率、静息痛缓解情况、溃疡愈合情况、通畅率、截肢率及远期预后。总体技术成功率为9/9，其中8例股动脉内膜剥脱取栓术（4例大隐静脉补片血管成形术、1例吻合缝合术、3例单纯缝合术），4例人工血管股-股旁路移植术，1例大隐静脉股浅动脉旁路移植术。术后静息痛立即消失。随访时间10～44个月。所有患者均存活。半年通畅率为9/9，1年通畅率为6/8。除1例术后因持续大量吸烟导致足背溃疡至今明显缩小但未愈合外，其余患者随访期间均无静息痛发作或足部溃疡复发。8例患者中，3例近期有间歇性跛行的患者存在持续中度吸烟（每天10～20支或重度被动吸烟）。对于累及股深动脉或其流入道血管的血栓闭塞性脉管炎患者，血管重建术应作为首选，远期预后良好。术后吸烟暴露（包括被动吸烟）对TAO患者预后影响极大，必须再次强调并加强戒烟教育。
