Stierli P, Koella C H
Chirurgische Klinik, Kantonsspital Aarau.
Helv Chir Acta. 1993 Sep;60(1-2):259-61.
In situ saphenous vein bypass for infrainguinal reconstructions achieves excellent results, especially for distal anastomoses. The achilles heel of the method is the complete and atraumatic disruption of the valves and the location of significant tributaries of the saphenous vein. An intraoperative quality control is necessary to mend early patency rates. Several control instruments are described: intraoperative arteriography, duplex- or Doppler sonography and angioscopy. We describe the technique of a semiclosed angioscopy guided technique with a novel flushing valvulotome. We use an angiofiberscope with 2.2 or 1.4 mm outer diameter, being introduced through the proximal exposed end of the saphenous vein. Through the distal end or a side branch a modified Mill's valvulotome with a flushing channel (flexible or non flexible) is moved upwards to the angioscope. Every valve cusp is incised under direct vision in a retrograd direction. Simultaneously relevant tributaries are angioscopically located and ligated through small skin incisions. To use the potential of angioscopy we have developed the occluder valvulotome, making endoluminal embolization of tributaries of the saphenous vein possible. Details of these techniques are described.
原位大隐静脉旁路术用于腹股沟下血管重建可取得优异效果，尤其是对于远端吻合。该方法的薄弱环节在于瓣膜的完全且无创性破坏以及大隐静脉重要分支的位置。术中质量控制对于提高早期通畅率很有必要。介绍了几种控制手段：术中动脉造影、双功超声或多普勒超声以及血管内镜检查。我们描述了一种使用新型冲洗瓣膜刀的半封闭式血管内镜引导技术。我们使用外径为2.2或1.4毫米的血管纤维镜，通过大隐静脉近端暴露端插入。通过远端或侧支将带有冲洗通道（柔性或非柔性）的改良米尔瓣膜刀向上移至血管内镜处。在直视下沿逆行方向切开每个瓣膜尖。同时通过血管内镜定位相关分支，并通过小皮肤切口进行结扎。为发挥血管内镜的潜能，我们研发了封堵瓣膜刀，使大隐静脉分支的腔内栓塞成为可能。文中描述了这些技术的细节。
