Nguyen Trung, Tenewitz Paul, Shames Murry, Parikh Rajavi
Division of Vascular Surgery, University of South Florida College of Medicine, Tampa, FL, USA.
Department of Surgery, University of South Florida Morsani College of Medicine, USA.
Vasc Endovascular Surg. 2025 Feb;59(2):191-197. doi: 10.1177/15385744241285240. Epub 2024 Sep 21.
Management of limb ischemia in the setting of malignancy with history of resection and/or radiation presents a unique challenge. Radiation arteritis contributing to limb ischemia may not respond to endovascular intervention. Furthermore, significant tissue scarring from extensive resection and/or radiation can increase the risk of complications with open intervention and limit revascularization options. Utilization of an axillary to popliteal artery bypass using a lateral approach to the popliteal artery has been described as a reasonable alternative in these challenging cases.
The patient is a 68-year-old male with history of liposarcoma of the left groin, scrotum, and medial thigh for which he underwent multiple resections, flap reconstruction, and skin graft. He had a recurrence 2 years later and underwent repeat resection, placement of brachytherapy catheters, vertical rectus abdominal flap, and external beam radiation. He now presents with Rutherford 2B acute limb ischemia with associated left foot drop. Computed tomography angiography was performed and revealed an occluded left common femoral artery stent, proximal left superficial and deep femoral artery occlusion, and thrombosis of the left femoral vein. An attempt was made at endovascular recanalization without success. He subsequently underwent left axillary-to-lateral above knee popliteal artery bypass with a 6 mm ringed polytetrafluoroethylene graft, tibial thrombectomy, and 4 compartment fasciotomy.
Post-operatively, his pain resolved. He continued to have left foot drop but recovered his ability to ambulate with a walker. He was ultimately discharged on post-operative day 11 to an inpatient rehabilitation facility on aspirin and apixaban.
Hostile groin secondary to infection, malignancy requiring resection/radiation presents a unique challenge for revascularization. When endovascular revascularization or obturator bypass are not feasible options, axillary-to-lateral above knee popliteal artery bypass is a described, feasible alternative approach to restore blood flow in this challenging patient population.
对于有切除和/或放疗史的恶性肿瘤患者肢体缺血的管理是一项独特的挑战。导致肢体缺血的放射性动脉炎可能对血管内介入治疗无反应。此外，广泛切除和/或放疗造成的显著组织瘢痕会增加开放手术干预的并发症风险，并限制血管重建的选择。在这些具有挑战性的病例中，采用经外侧入路至腘动脉的腋-腘动脉旁路移植术被描述为一种合理的替代方案。
该患者为68岁男性，有左侧腹股沟、阴囊及大腿内侧脂肪肉瘤病史，为此接受了多次切除、皮瓣重建和植皮手术。2年后复发，再次接受切除、近距离放疗导管置入、腹直肌垂直皮瓣和外照射放疗。他现在表现为Rutherford 2B级急性肢体缺血并伴有左足下垂。进行了计算机断层扫描血管造影，显示左股总动脉支架闭塞、左股浅动脉和股深动脉近端闭塞以及左股静脉血栓形成。尝试进行血管内再通但未成功。随后，他接受了左腋-膝上外侧腘动脉旁路移植术，使用6毫米带环聚四氟乙烯移植物，进行了胫部血栓切除术和四室筋膜切开术。
术后，他的疼痛缓解。他仍有左足下垂，但恢复了使用助行器行走的能力。他最终在术后第11天出院，前往住院康复机构，服用阿司匹林和阿哌沙班。
继发于感染及需要切除/放疗的恶性肿瘤导致的腹股沟区情况不佳，给血管重建带来了独特的挑战。当血管内血管重建或闭孔动脉旁路移植术不可行时，腋-膝上外侧腘动脉旁路移植术是一种已被描述的、可行的替代方法，可在这一具有挑战性的患者群体中恢复血流。
