Lee B Y, Guerra J
Department of Surgery of the Veterans Affairs Medical Center, Castle Point, NY.
J Am Paraplegia Soc. 1994 Oct;17(4):171-6. doi: 10.1080/01952307.1994.11735932.
The axillofemoral bypass graft, an extra-anatomic graft, connects the axillary artery to the femoral artery and is used in the treatment of significant aortoiliac occlusive disease in poor-risk patients. A common indication for axillofemoral bypass is a "hostile abdomen" (postoperative adhesions, neoplasms or radiation). Less frequent indications are aortic mycotic aneurysm, infected aortobifemoral bypass graft, aortoduodenal fistula, inflammatory aneurysm and extensive retroperitoneal fibrosis. Spinal cord injured patients with peripheral arterial disease have two problems: 1) lack of premonitory symptoms (absence of claudication, paresthesias or rest pain) and 2) difficulty preventing pressure sores in the already poorly perfused limb. Indications for arterial reconstructive surgery are more drastic in this set of patients (impending gangrene and/or ischemic ulcers). Many spinal cord injured patients have sources of possible contamination (cystostomy and/or colostomy) which make intra-abdominal clean surgery impossible. We present a spinal cord injured patient with a permanent cystostomy and impending gangrene of the left foot. He underwent a left axillofemoral bypass graft and had a good postoperative course. We conclude that axillofemoral bypass graft is a good alternative for limb salvage in the spinal cord injured patient, especially when there is a source of possible contamination (colostomy and/or cystostomy) that would interfere with more common bypass grafting. The role of the noninvasive vascular laboratory for early detection of vascular disease is emphasized.
腋股旁路移植术是一种解剖外旁路移植术，它将腋动脉与股动脉连接起来，用于治疗高危患者的严重主髂动脉闭塞性疾病。腋股旁路移植术的常见适应证是“腹部情况不佳”（术后粘连、肿瘤或放疗）。较少见的适应证包括主动脉霉菌性动脉瘤、感染性主动脉双股旁路移植术、主动脉十二指肠瘘、炎性动脉瘤和广泛的腹膜后纤维化。患有周围动脉疾病的脊髓损伤患者有两个问题：1）缺乏先兆症状（无间歇性跛行、感觉异常或静息痛），2）在本已灌注不良的肢体上预防压疮困难。在这类患者中，动脉重建手术的适应证更为严格（即将发生坏疽和/或缺血性溃疡）。许多脊髓损伤患者存在可能的污染源（膀胱造瘘术和/或结肠造瘘术），这使得腹腔内清洁手术无法进行。我们报告一例患有永久性膀胱造瘘术且左足即将发生坏疽的脊髓损伤患者。他接受了左腋股旁路移植术，术后恢复良好。我们得出结论，腋股旁路移植术是脊髓损伤患者肢体挽救的良好选择，尤其是当存在可能干扰更常见旁路移植术的污染源（结肠造瘘术和/或膀胱造瘘术）时。强调了无创血管实验室在早期检测血管疾病中的作用。
