Sandmann W, Lerut J, Nier H, Kremer K
Chirurg. 1979 Nov;50(11):707-18.
Thirty-three patients with one or several late occlusions in 43 limbs of aortofemoral dacron grafts underwent 56 reconstructions because of impending limb loss. Thrombectomy alone with patch closure was less successful. Excision of the femoral anastomosis, resection of the distal part of the occluded prosthetic limb and replacement by a new velours graft tube together with profundaplasty and further downstream reconstruction revealed the best results. The early reocclusion rate was 10%, the late reocclusion rate was 10%. There was no operative mortality and no amputation. Two late deaths occurred, in one case due to grade III infection with sepsis. Another late graft infection was successfully managed by an extraanatomic bypass and excision of the infected limb. The reasons for late occlusions of aortofemoral grafts were found to be incomplete reconstruction of the outflow tract, technical failure at the time of primary reconstruction and progressive atherosclerosis. Hypertonus was common in all cases with progression of the disease. Technical details of the operative management for late occlusion are presented.
43条肢体的主-股动脉涤纶移植血管出现一处或多处晚期闭塞的33例患者，因即将出现肢体丧失而接受了56次重建手术。单纯血栓切除术加补片闭合术的成功率较低。切除股动脉吻合口、切除闭塞人工血管肢体的远端部分并用新的绒面移植管替换，同时进行股深动脉成形术和更远端的重建，效果最佳。早期再闭塞率为10%，晚期再闭塞率为10%。无手术死亡病例，也未进行截肢。发生了2例晚期死亡，1例死于Ⅲ级感染伴败血症。另一例晚期移植血管感染通过解剖外旁路和切除感染肢体成功处理。发现主-股动脉移植血管晚期闭塞的原因是流出道重建不完全、初次重建时的技术失误以及进行性动脉粥样硬化。在所有病情进展的病例中，高血压都很常见。本文介绍了晚期闭塞手术治疗的技术细节。
