Phifer T J, Gerlock A J, Vekovius W A, Rich N M, McDonald J C
Ann Surg. 1984 Feb;199(2):241-3. doi: 10.1097/00000658-198402000-00018.
Only a small subset of patients with combined superficial femoral artery and vein injuries results in amputation. The importance of the venous component as a risk factor for amputation is uncertain. Ligation vs. reconstruction of venous injuries is controversial. For clarification of these issues, we analyzed retrospectively multiple risk factors for amputation in combined superficial femoral artery and vein injuries in a civilian population. There were 25 patients treated in a 20-year period. Sixteen injuries were caused by small caliber missiles, six by shotgun blasts, and three by knife wounds. Three patients (12%) ultimately underwent amputation. The major risk factor for amputation was method of vascular reconstruction. All three amputations underwent ligation of the superficial femoral vein with arterial reconstruction by placement of a reversed interposition saphenous vein graft (p = 0.0009). None of the remaining 22 patients with salvaged limbs underwent reconstruction by this combination of techniques. Consequently, the authors emphasize the importance of venous reconstruction, particularly in combined injuries with major arterial involvement requiring interposed grafts.
仅有一小部分股浅动静脉联合损伤的患者最终需要截肢。静脉损伤作为截肢风险因素的重要性尚不确定。对于静脉损伤，结扎与重建的做法存在争议。为了阐明这些问题，我们回顾性分析了平民人群股浅动静脉联合损伤后截肢的多种风险因素。在20年期间共治疗了25例患者。16例损伤由小口径导弹所致，6例由霰弹枪爆炸所致，3例由刀伤所致。3例患者（12%）最终接受了截肢手术。截肢的主要风险因素是血管重建方式。所有3例截肢患者均接受了股浅静脉结扎，并通过植入一段倒置的大隐静脉移植段进行动脉重建（p = 0.0009）。其余22例肢体得以保全的患者均未采用这种联合技术进行重建。因此，作者强调了静脉重建的重要性，尤其是在伴有需要植入移植段的主要动脉损伤的联合损伤中。
