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我的做法：内镜辅助下肢原位动脉重建术。

How I do it: Endoscope-assisted in situ arterial reconstruction of the lower limb.

作者信息

Michels Alison, Baghdadwala Mufaddal, Yacob Michael

机构信息

Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada.

Division of General Surgery, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada.

出版信息

J Vasc Surg Cases Innov Tech. 2024 May 9;10(4):101520. doi: 10.1016/j.jvscit.2024.101520. eCollection 2024 Aug.

DOI:10.1016/j.jvscit.2024.101520
PMID:38989263
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11234098/
Abstract

Arterial reconstruction with the great saphenous vein is a frequently performed vascular surgery technique for revascularization of chronic limb threatening ischemia. Surgeon variations of the procedure are common and aim to balance patency, limb salvage, complications, hospital resources, and technical feasibility. We describe a minimally invasive revascularization option using endoscope assistance for in situ great saphenous vein-arterial bypass to treat infrainguinal occlusive disease. We highlight patient selection, operating room setup, instrument details, and procedure strategies that facilitate the use of this technique. The development and refinement of minimally invasive techniques for lower extremity arterial bypass are critical to reduce wound complications and improve limb salvage outcomes in patients.

摘要

使用大隐静脉进行动脉重建是一种常用于慢性肢体威胁性缺血血运重建的血管外科技术。该手术的术式变化很常见，目的是平衡通畅率、肢体挽救率、并发症、医院资源和技术可行性。我们描述了一种使用内镜辅助进行原位大隐静脉-动脉旁路移植术的微创血运重建方案，用于治疗腹股沟下闭塞性疾病。我们重点介绍了有助于该技术应用的患者选择、手术室设置、器械细节和手术策略。下肢动脉旁路移植微创技术的发展和完善对于减少患者伤口并发症和改善肢体挽救效果至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ec0/11234098/3be20cfaeb03/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ec0/11234098/fd5a58c9f563/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ec0/11234098/661fbf701aeb/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ec0/11234098/42b47fcae50f/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ec0/11234098/3be20cfaeb03/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ec0/11234098/fd5a58c9f563/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ec0/11234098/661fbf701aeb/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ec0/11234098/42b47fcae50f/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ec0/11234098/3be20cfaeb03/gr4.jpg

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本文引用的文献

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Towards Endoscopic No-Touch Saphenous Vein Graft Harvesting in Coronary Bypass Surgery.迈向冠状动脉旁路移植术中内镜下非接触式隐静脉采集。
Braz J Cardiovasc Surg. 2022 Sep 2;37(Spec 1):57-65. doi: 10.21470/1678-9741-2022-0144.
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Global vascular guidelines on the management of chronic limb-threatening ischemia.全球血管指南：慢性肢体威胁性缺血的管理。
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2018 ESC/EACTS Guidelines on myocardial revascularization.2018年欧洲心脏病学会/欧洲心胸外科学会心肌血运重建指南。
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Study Comparing Vein Integrity and Clinical Outcomes in Open Vein Harvesting and 2 Types of Endoscopic Vein Harvesting for Coronary Artery Bypass Grafting: The VICO Randomized Clinical Trial (Vein Integrity and Clinical Outcomes).比较冠状动脉旁路移植术中开放静脉采集与两种内镜静脉采集方式的静脉完整性及临床结局的研究：VICO随机临床试验（静脉完整性与临床结局）
Circulation. 2017 Oct 31;136(18):1688-1702. doi: 10.1161/CIRCULATIONAHA.117.028261. Epub 2017 Jun 21.
5
Endoscopic vein harvest does not negatively affect patency of great saphenous vein lower extremity bypass.内镜下静脉采集对大隐静脉下肢旁路移植的通畅性没有负面影响。
J Vasc Surg. 2016 Jun;63(6):1546-54. doi: 10.1016/j.jvs.2016.01.032. Epub 2016 Mar 19.
6
Endoscopic saphenous vein and radial harvest: state-of-the-art.内镜下大隐静脉和桡动脉获取：最新技术
Curr Opin Cardiol. 2015 Nov;30(6):624-8. doi: 10.1097/HCO.0000000000000231.
7
Endoscopic vein harvesting in lower extremity arterial bypass: a systematic review.下肢动脉旁路内镜下静脉采集：系统评价。
Eur J Vasc Endovasc Surg. 2014 Jun;47(6):621-39. doi: 10.1016/j.ejvs.2014.02.009. Epub 2014 Mar 15.
8
Endoscopic versus open saphenous vein graft harvest for lower extremity bypass in critical limb ischemia.内镜下与开放手术取大隐静脉用于下肢严重缺血的旁路移植术。
J Vasc Surg. 2014 Jan;59(1):136-44. doi: 10.1016/j.jvs.2013.06.072.
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Endoscopically assisted in situ lower extremity bypass graft: a preliminary report of a new minimally invasive technique.内镜辅助原位下肢旁路移植术：一种新型微创技术的初步报告
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