Whiteley M S, Magee T R, Torrie E P, Galland R B
Department of Surgery, Royal Berkshire Hospital, Reading, U.K.
Eur J Vasc Endovasc Surg. 1998 Sep;16(3):254-8. doi: 10.1016/s1078-5884(98)80228-1.
To describe our experience of a modified technique for carrying out remote endarterectomy for superficial femoral artery occlusive disease.
A 4-French arterial dilator is inserted using a Smart needle into the popliteal artery below the occlusion. A remote endarterectomy is carried out through an arteriotomy in the proximal superficial femoral artery. The atheroma is cut distal to the lower extent of disease using a Moll ring cutter. The lower flap of atheroma is secured with an intraluminal stent inserted from the arteriotomy in the superficial femoral artery. The arteriotomy is extended into the common femoral artery and closed with a vein patch.
The procedure was completed in 21 of 26 limbs. In 18 cases the superficial femoral artery remained patent at 30 days. Of the 21 cases all but four stayed in hospital for one night. A successful femoropopliteal bypass was carried out in the five patients in whom the procedure was not completed.
Insertion of the dilator into the popliteal artery distal to the occlusion before carrying out the remote endarterectomy has two advantages. Firstly, the stent insertion is carried out in the correct plane and prevents dissection of the distal cut atheroma when attempting to pass the guidewire from above. Secondly, the procedure can be carried out under simple image intensification without sophisticated radiological equipment. The early results are encouraging and further evaluation of the technique is justifiable.
描述我们采用改良技术进行股浅动脉闭塞性疾病远端动脉内膜切除术的经验。
使用智能针将4法式动脉扩张器插入闭塞下方的腘动脉。通过股浅动脉近端的动脉切开术进行远端动脉内膜切除术。使用莫尔环形切割器在病变下限远端切割动脉粥样硬化斑块。从股浅动脉的动脉切开处插入腔内支架固定动脉粥样硬化斑块的下瓣。将动脉切开术延伸至股总动脉并用静脉补片封闭。
26条肢体中的21条完成了该手术。18例患者股浅动脉在30天时保持通畅。21例患者中除4例之外均住院一晚。5例未完成该手术的患者成功进行了股腘动脉旁路移植术。
在进行远端动脉内膜切除术之前将扩张器插入闭塞远端的腘动脉有两个优点。首先，支架插入在正确的平面进行，可防止在试图从上方穿过导丝时远端切割的动脉粥样硬化斑块发生剥离。其次，该手术可在简单的影像增强设备下进行，无需复杂的放射设备。早期结果令人鼓舞，对该技术进行进一步评估是合理的。
