Robbs J V, Wylie E J
Ann Surg. 1981 Mar;193(3):346-52. doi: 10.1097/00000658-198103000-00017.
Fifty-eight patients have been treated for recurrent lower limb ischemia following bypass surgery for aortoiliac occlusive disease over a three-year period. Based on clinical case notes, angiograms, operative notes and histologic examination of endarterectomy specimens, 32 patients (55.2%) were found to have progressive atherosclerotic occlusion involving the inflow (seven patients) or outflow (25 patients) tracts. Seven patients (12.0%) had problems related to graft angulation or mural thrombus fragmentation and, in four patients, anastomotic fibroplasia was demonstrated. Fifteen patients (25.9%) had not had their disease bypassed by the primary operation and required reoperation within one year. It is suggested that the use of juxtarenal end-to-end proximal anastomosis, extending to the groins distally in most cases, and good graft to host size match may be important considerations. Management entailed major aortic reconstructions in 28 patients, and local groin procedures or crossover grafts in 30 patients. There was one postoperative death (1.7%). Two patients had amputations (3.4%) although all grafts were functioning at the time the patients were discharged from the hospital. Major complications were more frequent following aortic reconstruction, and operations of this magnitude may, possibly, be confined to patients with aortic inflow obstruction, infection involving the graft body or redundancy of the graft body causing sufficient angulation to cause obstruction.
在三年时间里，58例患者因主髂动脉闭塞性疾病行搭桥手术后出现复发性下肢缺血而接受治疗。根据临床病例记录、血管造影、手术记录以及动脉内膜切除术标本的组织学检查，发现32例患者（55.2%）存在进行性动脉粥样硬化闭塞，累及流入道（7例患者）或流出道（25例患者）。7例患者（12.0%）存在与移植物成角或壁血栓碎裂相关的问题，4例患者显示有吻合口纤维增生。15例患者（25.9%）在初次手术时疾病未被绕过，需要在一年内再次手术。建议使用肾旁端端近端吻合术，在大多数情况下向远端延伸至腹股沟，以及移植物与宿主大小良好匹配可能是重要的考虑因素。治疗方法包括28例患者进行主动脉大重建，30例患者进行局部腹股沟手术或交叉移植物手术。术后有1例死亡（1.7%）。2例患者接受了截肢手术（3.4%），尽管所有移植物在患者出院时均功能良好。主动脉重建后主要并发症更为常见，这种规模的手术可能仅限于存在主动脉流入道梗阻、累及移植物主体的感染或移植物主体冗余导致足够成角从而引起梗阻的患者。
