Yeager R A, Hobson R W, Lynch T G, Jamil Z, Padberg F T, Lee B C, Swan K G
Am Surg. 1984 Mar;50(3):155-8.
A 3-year clinical experience is analyzed to define preferred surgical management and amputation rates for popliteal as well as infrapopliteal arterial injuries. Ten patients with popliteal arterial trauma were successfully managed without amputation, however, five of 11 (45%) patients with infrapopliteal arterial trauma required amputation. While essentially all popliteal arterial injuries mandate repair, recommendations for repair or ligation of isolated tibial arterial injuries are based on presence of distal ischemia, the patient's associated injuries, as well as estimated operating time for reconstruction. With injury to two or three infrapopliteal arteries, distal ischemia is usually present and arterial repair indicated, unless there has been severe crush injury, prolonged delay, or extended surgery would jeopardize the patient's life. A management protocol for patients with distal ischemia related to popliteal or infrapopliteal arterial trauma should include prompt surgical intervention, liberal use of fasciotomy, intraoperative arteriography, as well as the selective use of intraluminal shunts.
分析了3年的临床经验，以确定腘动脉以及腘以下动脉损伤的首选手术治疗方法和截肢率。10例腘动脉创伤患者成功接受治疗且未截肢，然而，11例腘以下动脉创伤患者中有5例（45%）需要截肢。虽然基本上所有腘动脉损伤都需要修复，但对于孤立的胫动脉损伤进行修复或结扎的建议是基于远端缺血的存在、患者的合并损伤以及重建的估计手术时间。当两到三条腘以下动脉受损时，通常会出现远端缺血，此时应进行动脉修复，除非存在严重挤压伤、长时间延误或延长手术会危及患者生命。针对与腘动脉或腘以下动脉创伤相关的远端缺血患者的管理方案应包括及时的手术干预、广泛使用筋膜切开术、术中动脉造影以及选择性使用腔内分流术。
