Scott C M, Pinson W, Inahara T
Surgery. 1984 Jul;96(1):122-5.
Blunt injury to the common femoral artery with associated extensive soft tissue damage presented significant problems in arterial reconstruction as exemplified in this case report. Arterial restoration resolved into three phases. Initially, the femoral artery was replaced with an ipsilateral saphenous vein graft; in the second phase for septic complications, an axillofemoral bypass graft was used; and in the third phase, the contralateral saphenous vein graft was placed sequentially from the common iliac to the deep femoral to the superficial femoral to the popliteal artery. The contralateral saphenous vein had been placed in an arterialized circuit for 9 months before its harvest by means of a distal arteriovenous fistula. The primary consideration was to enlarge the small vein to approximate the caliber of the external iliac and common femoral artery. Of secondary concern was the potential for delayed aneurysmal degeneration as reported incidence in much higher in younger patients. Whether in situ arterialization influences this outcome is yet to be documented. At 36 months the saphenous vein graft is palpably normal and the ankle-brachial index is 1.0.
股总动脉钝性损伤合并广泛软组织损伤给动脉重建带来了重大问题，本病例报告即为例证。动脉修复分为三个阶段。最初，用同侧大隐静脉移植替代股动脉；第二阶段针对感染并发症，采用腋股旁路移植；第三阶段，将对侧大隐静脉依次从髂总动脉放置至股深动脉、股浅动脉直至腘动脉。对侧大隐静脉在通过远端动静脉瘘获取前已在动脉化循环中放置了9个月。首要考虑的是扩大细小静脉以接近髂外动脉和股总动脉的管径。次要关注点是如报道所示年轻患者中延迟性动脉瘤样退变的可能性更高。原位动脉化是否会影响这一结果尚无文献记载。36个月时，大隐静脉移植触诊正常，踝肱指数为1.0。
