Vascular Service, Department of Surgery, Changi General Hospital, Singapore, Singapore.
Vasc Endovascular Surg. 2023 Oct;57(7):806-810. doi: 10.1177/15385744231173193. Epub 2023 May 4.
Primary above-knee amputation (AKA) may at times be the only option for unsalvageable acute lower limb ischemia. However, occlusion of the femoral arteries may result in poor inflow and contribute to wound complications such as stump gangrene and sepsis. Previously attempted inflow revascularisation techniques include surgical bypass and percutaneous angioplasty and/or stenting.
We present a case of a 77-year-old lady with unsalvageable acute right lower limb ischemia secondary to cardioembolic occlusion of the common (CFA), superficial (SFA) and deep (PFA) femoral arteries. We performed a primary AKA with inflow revascularisation using a novel surgical technique involving endovascular retrograde embolectomy of the CFA, SFA and PFA via the SFA stump. The patient made an uneventful recovery without any wound complications. Detailed description of the procedure is followed by a discussion of the literature on inflow revascularisation in the treatment and prevention of stump ischemia.
在某些情况下，原发高位截肢（AKA）可能是无法挽救的急性下肢缺血的唯一选择。然而，股动脉闭塞可能导致血流不畅，并导致残端坏疽和败血症等伤口并发症。先前尝试的血流重建技术包括手术旁路和经皮血管成形术和/或支架置入术。
我们报告了一例 77 岁女性患者，因心源性栓子阻塞股总动脉（CFA）、股浅动脉（SFA）和股深动脉（PFA）而发生无法挽救的急性右下肢缺血。我们采用一种新的手术技术进行原发 AKA，该技术通过 SFA 残端进行 CFA、SFA 和 PFA 的血管内逆行取栓术进行血流重建。患者恢复顺利，无任何伤口并发症。详细描述了该手术过程，并讨论了文献中关于血流重建在预防和治疗残端缺血方面的应用。
