Verhelst R, Bruneau M, Nicolas A L, Frangi R, El Khoury G, Noirhomme P, Dion R
Service de Chirurgie Thoacique et Cardio-Vasculaire, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgique.
Ann Vasc Surg. 1997 Sep;11(5):505-9. doi: 10.1007/s100169900082.
From July 1989 to July 1994, a total of 44 popliteal-to-distal artery bypasses were performed in 36 patients (29 men and seven women, mean age 62 +/- 10 years). These procedures accounted for 8.8% of all infrainguinal revascularizations performed during that period. Risk factors included diabetes in 33 patients (92%), smoking in 18 (50%), and coronary artery disease in 15 (42%). Prior to revascularization all patients were at risk of limb loss. Tissue necrosis was present in 31 cases (71%), ulceration in eight cases (18%), and rest pain in five cases (11%). Patency of the femoral and popliteal arteries was confirmed prior to surgery in all cases. Intraoperative percutaneous angioplasty of the superficial femoral artery was performed in three cases. Proximal anastomosis was made to the distal popliteal artery in all cases. A total of 52 distal anastomoses (eight sequential bypasses) were made on the following arteries: posterior tibial artery in 13 cases, anterior tibial artery in eight cases, peroneal artery in six cases, plantar artery in two cases, and dorsalis pedis artery in 21 cases. The greater saphenous vein was used as graft material in 42 cases (95%) and the lesser saphenous vein in two cases (5%). No patient died during hospitalization. Early bypass occlusion occurred in three cases (6.8%) and led to amputation in all cases. Secondary patency and limb salvage rates at 3 years calculated using the actuarial method were 74% and 82% respectively. Bypass thrombosis due to superficial femoral artery deterioration was not observed in any case. The present study indicates that popliteal-to-distal artery bypass is a simple, durable, and low-risk method of lower limb revascularization. Medium-term results are promising and support routine use of popliteal-to-distal artery bypass for limb salvage in patients without significant stenosis of the superficial femoral artery.
1989年7月至1994年7月，36例患者（29例男性，7例女性，平均年龄62±10岁）共接受了44次腘动脉至远端动脉搭桥手术。这些手术占该时期所有下肢血管重建手术的8.8%。危险因素包括33例患者（92%）患有糖尿病，18例（50%）吸烟，15例（42%）患有冠状动脉疾病。在血管重建术前，所有患者均有肢体丧失风险。31例（71%）存在组织坏死，8例（18%）有溃疡，5例（11%）有静息痛。所有病例术前均证实股动脉和腘动脉通畅。3例术中对股浅动脉进行了经皮血管成形术。所有病例近端吻合均至腘动脉远端。共对以下动脉进行了52次远端吻合（8次序贯搭桥）：13例至胫后动脉，8例至胫前动脉，6例至腓动脉，2例至足底动脉，21例至足背动脉。42例（95%）使用大隐静脉作为移植材料，2例（5%）使用小隐静脉。住院期间无患者死亡。3例（6.8%）发生早期搭桥闭塞，均导致截肢。采用精算方法计算的3年二级通畅率和肢体挽救率分别为74%和82%。未观察到因股浅动脉病变导致的搭桥血栓形成。本研究表明，腘动脉至远端动脉搭桥是一种简单、持久且低风险的下肢血管重建方法。中期结果令人鼓舞，支持在股浅动脉无明显狭窄的患者中常规使用腘动脉至远端动脉搭桥进行肢体挽救。
