Gelabert H A, Colburn M D, Moore W S
Section of Vascular Surgery, UCLA School of Medicine 90095-6904, USA.
Ann Vasc Surg. 1997 Jul;11(4):378-82. doi: 10.1007/s100169900064.
Lesser saphenous vein grafts have become an important element in limb salvage surgery. Their location frequently dictates that the graft be translocated for use. This incurs the disadvantages of ischemia and increased manipulation of the graft and loses the advantages of an in-situ bypass. The use of the lesser saphenous vein as an in-situ graft for tibial artery reconstruction offers the advantages of reduced vein graft injury and improved patency. Technical requirements for an in-situ lesser saphenous bypass include that graft inflow be based on the popliteal artery, the vein length suffice to reach the target artery, and the runoff vessel have adequate size, length, and collateral connections to allow reasonable likelihood of success. The surgical approach requires the patient be in a prone position allowing a posterior longitudinal incision in the leg. Exposure of the distal portion of the peroneal artery is accomplished by separating the peroneus brevis and flexor hallucis longus. The peroneal artery is then visualized when the fibular attachments of the flexor hallucis longus are divided. Our experience indicates that the lesser saphenous vein may be successfully used as an in-situ conduit for bypass to the distal peroneal artery. Technical innovations such as flexible valvulotomes with detachable heads, and tourniquet control of bleeding facilitate the operation. A posterior approach to the popliteal and crural arteries affords the ability to use the lesser saphenous vein as an in-situ bypass.
小隐静脉移植物已成为肢体挽救手术中的一个重要组成部分。其位置常常决定移植物需要移位使用。这带来了缺血以及移植物操作增加的缺点，并且失去了原位旁路移植的优势。使用小隐静脉作为原位移植物进行胫动脉重建具有减少静脉移植物损伤和提高通畅率的优势。原位小隐静脉旁路移植的技术要求包括移植物流入基于腘动脉，静脉长度足以到达目标动脉，并且流出血管具有足够的大小、长度和侧支连接以确保有合理的成功可能性。手术入路要求患者处于俯卧位，以便在腿部做后正中切口。通过分离短腓骨肌和拇长屈肌来显露腓动脉远端部分。当切断拇长屈肌的腓骨附着点时即可看到腓动脉。我们的经验表明，小隐静脉可成功用作向腓动脉远端进行旁路移植的原位管道。诸如带有可拆卸头部的柔性瓣膜刀以及用止血带控制出血等技术创新有助于手术操作。通过后侧入路显露腘动脉和小腿动脉能够使用小隐静脉进行原位旁路移植。
