Gayral M, Duchemin J F, Cavillon A, Chevalier J M
Service de chirurgie vasculaire, Hôpital Edouard-Herriot, Lyon.
Rev Prat. 1995 Jan 1;45(1):75-81.
Among arterial reconstruction procedures, thromboendarterectomy has progressively left place to prosthetic grafts for aorto-iliac surgery. At infra-inguinal level, inversed or in situ venous grafts allow distal revascularisations down to the foot. Lumbar sympathectomy keeps some indications. Indications depend upon the level of arterial obstruction, the symptoms, and the operative risk of the patient. At aorto-iliac level surgery provides excellent results; indications for proximal surgery are large; operative risk is the main limiting factor. At infra-inguinal level surgery is well tolerated but permeability rates are not as good as with aorto-iliac surgery; distal surgery is appropriate only is case of critical ischaemia, when everything must be done for limb salvage.
在动脉重建手术中，在主动脉-髂动脉手术中，血栓内膜切除术已逐渐被人工血管所取代。在腹股沟下水平，倒置或原位静脉移植可实现足部以下的远端血管重建。腰交感神经切除术仍有一些适应证。适应证取决于动脉阻塞的程度、症状以及患者的手术风险。在主动脉-髂动脉水平，手术效果良好；近端手术的适应证广泛；手术风险是主要限制因素。在腹股沟下水平，手术耐受性良好，但通畅率不如主动脉-髂动脉手术；远端手术仅适用于严重缺血的情况，此时必须尽一切努力挽救肢体。
