Imparato A M
Surgery. 1983 Jan;93(1 Pt 1):112-6.
Lower limb ischemia represents the most common single threat to the success of operations for abdominal aortic aneurysms. It can occur because of distal embolization from a number of sites or because of thrombosis either at sites of anastamosis or in diseased arteries at or beyond sites of clamping. Preoperative angiographic studies in patients with missing lower extremity pulses aid in planning reconstructive procedures if ischemia occurs in the postoperative period. Systemic heparinization during the stage of interruption of the circulation and specific techniques of dissection, clamping, anastamosis, flushing, and unclamping resulted in an incidence of 0.57% postoperative limb-threatening ischemia in a series of 700 abdominal aneurysm operations in which the incidence of lower limb gangrene was 0.28%.
下肢缺血是腹主动脉瘤手术成功面临的最常见单一威胁。它可能由于多个部位的远端栓塞而发生，也可能由于吻合部位或夹闭部位及以远病变动脉处的血栓形成而发生。对于下肢脉搏缺失的患者，术前血管造影研究有助于在术后发生缺血时规划重建手术。在一系列700例腹主动脉瘤手术中，在循环阻断阶段进行全身肝素化以及采用特定的解剖、夹闭、吻合、冲洗和松开技术，导致术后肢体威胁性缺血的发生率为0.57%，其中下肢坏疽的发生率为0.28%。
