Sanchez L A, Marin M L, Veith F J, Cynamon J, Suggs W D, Wengerter K R, Schwartz M L, Lyon R T, Bakal C W, Parodi J C
Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, N.Y. 10467, USA.
Ann Vasc Surg. 1995 Jan;9(1):1-8. doi: 10.1007/BF02015310.
Endovascular grafting is a technique that combines the use of intravascular stents and prosthetic grafts to fabricate devices with unique properties. The purpose of this study is to describe the use of endovascular graft technology in the treatment of failed or failing standard aortoiliofemoral reconstructions. Over a 15-month period five patients with limb-threatening ischemia and failed aortofemoral or iliofemoral reconstructions underwent successful placement of six endovascular grafts to revascularize seven severely ischemic lower extremities. Standard thin-walled 6 mm polytetrafluoroethylene grafts and Palmaz balloon-expandable stents were used to fashion each reconstruction. In addition to the primary endovascular grafts, three patients underwent immediate femoropopliteal bypasses to improve distal outflow and one patient had a femorofemoral bypass graft to restore circulation to the contralateral ischemic extremity. The ankle/brachial indices of all patients significantly improved after the procedure (from a mean of 0.32 to a mean of 0.75) and all grafts are patent to date (mean follow-up 10 months). There were no deaths or limb loss in this group of patients. These favorable results indicate that this minimally invasive approach, which permits a new arterial graft to be inserted through a remote access site, is a valuable method for providing unobstructed arterial inflow after aortoiliofemoral graft failure. This procedure may be particularly valuable when there are contraindications to the use of axillary arteries or the thoracic aorta as alternatives to complex reoperative abdominal aortic surgery.
血管内移植术是一种结合使用血管内支架和人工血管来制造具有独特性能装置的技术。本研究的目的是描述血管内移植技术在治疗失败或即将失败的标准主-髂-股动脉重建术中的应用。在15个月的时间里，5例患有肢体威胁性缺血且主-股动脉或髂-股动脉重建失败的患者成功植入了6个血管内移植物，以使7条严重缺血的下肢恢复血运。使用标准的6毫米薄壁聚四氟乙烯移植物和帕尔马球囊扩张支架进行每次重建。除了主要的血管内移植物外，3例患者立即进行了股-腘动脉旁路移植术以改善远端血流，1例患者进行了股-股动脉旁路移植术以恢复对侧缺血肢体的血液循环。术后所有患者的踝/臂指数均显著改善（从平均0.32提高到平均0.75），且所有移植物至今均保持通畅（平均随访10个月）。该组患者无死亡或肢体丢失情况。这些良好的结果表明，这种微创方法允许通过远处穿刺部位插入新的动脉移植物，是主-髂-股动脉移植物失败后提供通畅动脉血流的一种有价值的方法。当存在使用腋动脉或胸主动脉作为复杂再次手术腹主动脉手术替代方案的禁忌证时，该手术可能特别有价值。
