Vigorous Salvage of Below Knee Ischemic Limbs with Popliteo-paramalleolar Arterial Bypass

目的：下肢缺血是最具挑戰性的問題之一，通常具有很高的罹病率及死亡率。踝旁動脈之繞道手術適合使用於膝下缺血性壞死發生時, 而當近端之吻合口位於膕動脈時，可使用較短的隱靜脈做為繞道材料。在這個實驗中我們便要來評估使用較短的隱靜脈來實行膕動脈至踝旁動脈繞道手術之效果。材料與方法：從1999年3月1日至2002年8月31日共有43個病患因下肢缺血性壞死到本科接受手術治療，其中包含11位女性及32位男性,平均年齡為68.2歲。共有21次膕動脈至踝旁動脈繞道手術被施行，並有3種血管用來當作繞道材料:18次使用逆轉的隱靜脈(85.7%)，2次人工血管及隱靜脈的複合物(9.5%)，及1次原位之隱靜脈(4.8%)。臨床上利用血管攝影，血管檢查儀之踝-肱血壓比，都卜勒壓力圖及超音波來確定診斷，並追蹤至2004年12月31日止。結果：在所有施行手術的21個肢體中只有1個必須接受膝下截肢，其餘20個肢體皆保留住。另外有2位因術前即於前腳產生壞疽而必須接受前腳部分切除，但依舊可維持其足部之功能。結論：治療膝下缺血性壞死，不論使用逆轉的隱靜脈，或原位之隱靜脈，或是人工血管及隱靜脈的複合物來施行膕動脈至踝旁動脈之繞道手術皆可提供足部豐富之血流，對於傷口的癒合或積極之肢體保留皆有非常良好之成效。

關鍵字

膝下缺血性肢體壞死；肢體保留；踝旁動脈繞道手術；自體隱靜脈

並列摘要

Purpose: Ischemic limb is one of the most challenging problems and usually carries high morbidity and mortality. The paramalleolar arterial bypass is indicated when below knee ischemia does exist. Shorter length of the vein graft may be used if the proximal anastomosis is located at the popliteal artery. In this study, we will evaluate the effectiveness of popliteo-paramalleolar bypass with shorter saphenous vein grafts. Materials and methods: From 1st March 1999 through 31(superscript th) August 2002, 43 patients called at our section due to ischemic limbs. Patients, who were expired during follow-up, including 11 females and 32 males with a mean age of 68.2 years. Twenty-one popliteo-paramalleolar bypasses were performed. Three types of vein graft was used: reversed saphenous vein graft in 18 extremities (85.7%), composition graft in 2 extremities (9.5%), and in situ saphenous vein graft in 1 extremity (4.8%). The patients were diagnosed by angiography, Doppler segmental pressures (ankle-brachial pressure index & segmental pressure) and Dopplex ultrasonography and were followed till 31(superscript th) December, 2004 by the last two methods. Results: Only one below-knee amputation but no above knee amputation was done. In our series two partial forefoot amputations were done due to preoperative gangrene of partial forefoot. The limb salvage was achieved in 20 procedures. Conclusion: Popliteal arteries to paramalleolar arteries provide substantial perfusion to the foot. The results of wound healing and limb salvage in below knee ischemic limbs were excellent. Bypass with reversed saphenous vein, in situ saphenous vein or composition graft provide the same results.

並列關鍵字

Below knee ischemic limbs ； limb salvage ； paramalleolar arterial bypass ； autologous saphenous vein

國際替代計量

Vigorous Salvage of Below Knee Ischemic Limbs with Popliteo-paramalleolar Arterial Bypass

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