Ouriel K
Department of Surgery, University of Rochester, NY 14642, USA.
Semin Vasc Surg. 1997 Mar;10(1):23-30.
The distal popliteal artery and proximal crural vessels represent common locations for atherosclerotic occlusive disease, especially in the diabetic subpopulation. Symptoms such as pain at rest, distal ulceration, and gangrene are associated with a high risk of limb loss unless arterial flow can be restored. Surgical revascularization is the most appropriate treatment in these patients, using autogenous vein to bypass from the popliteal artery to a crural artery beyond the area of stenosis. The posterior approach is an ideal method with which to achieve this goal. Lesser saphenous vein may be harvested from the same incision used to expose the inflow and outflow vessels. The technique minimizes the length of required conduit and preserves the greater saphenous vein for subsequent use. The wound problems associated with medial vein harvest incisions are less frequent. A through knowledge of the anatomy of the region will allow one to use the posterior approach in selected patients with popliteal and infrapopliteal occlusive disease, providing an additional tool for use in patients with limb-threatening lower extremity ischemia.
腘动脉远端和小腿近端血管是动脉粥样硬化闭塞性疾病的常见发病部位，在糖尿病亚组人群中尤为如此。静息痛、远端溃疡和坏疽等症状与肢体丧失的高风险相关，除非能够恢复动脉血流。手术血运重建是这些患者最合适的治疗方法，采用自体静脉从腘动脉绕过狭窄区域至小腿动脉进行搭桥。后入路是实现这一目标的理想方法。小隐静脉可从用于暴露流入和流出血管的同一切口获取。该技术可将所需血管移植物的长度减至最短，并保留大隐静脉供后续使用。与在内侧采集静脉的切口相关的伤口问题较少见。对该区域解剖结构的透彻了解将使医生能够在选定的腘动脉和腘动脉以下闭塞性疾病患者中采用后入路，为治疗下肢严重缺血患者提供了一种额外的手段。
