【摘要】 目的 探讨下肢动脉搭桥术后再缺血的治疗策略。方法 选择2002年7月～2006年2月我院收治下肢动脉搭桥术后移植物闭塞患者21例，男17例，女4例，平均68.2岁；21例患者共行手术35例次：再次下肢动脉搭桥术16例次(45.7%)，单纯人工血管取栓手术10例次(28.6%)，人工血管取栓同时行股或腘动脉内膜剥脱术6例次(17.1%)，3例患者行截肢术(8.6%)。结果 35例次手术探查发现移植物闭塞原因以远侧流出道病变(62.9%)和远侧吻合口内膜增生(25.7%)为主。其中13例次术后再次闭塞行手术治疗，但人工血管搭桥术平均再发闭塞时间明显长于其他术式。2例患者围手术期死亡。17例患者末次行血运重建手术，术后随访6～44个月，平均17个月，未见缺血症状复发。结论 下肢动脉搭桥术后移植物闭塞原因以远侧流出道病变为主，再次搭桥手术可作为首选术式，术后缺血反复发作导致截肢。

    【关键词】 下肢；移植物闭塞；血管；截肢术

    Experience of surgical treatment for graft failure after lower extremity bypass grafting

    LI Qing-le,ZHANG Xiao-ming,ZHANG Xue-min,et al.The People’s Hospital of Peking University,Beijing 100044,China

    【Abstract】 Objective To report our experience of surgical treatment for 35 graft failure cases in 21 patients with lower extremity bypass and discuss the appropriate treatment strategy.Methods Twenty-one patients with graft failure after primary bypass grafting were treated from July 2002 to February 2006,including 17 males and 4 females with the mean age of 68.2 years.A total of 35 operations were applied: renewed bypass grafting for 16 cases(45.7%),thrombectomy of failed prosthetic grafts for 10 cases(28.6%),thrombectomy of failed prosthetic grafts and femoral or popliteal artery for 6 cases(17.1%),and below-knee amputation for 3 cases(8.6%).Results Intraoperative findings in 35 cases suggested that distal atherosclerotic lesions(62.9%)and distal anastomosis intimal hyperplasia(25.7%)account for most ischemic recurrences.Repeated graft failure occurred in 13 cases and renewed bypass grafting operations had a longer average recurrent interval than others.Two patients died during the perioperative period.Revascularization were accomplished in 17 patients followed up for 6 to 44 months with an average of 17months,and no ischemic recurrence was noticed.Conclusion Graft failures of lower extremities bypass is mainly caused by distal atherosclerotic progression and renewed bypass operation maybe a more promising choice.Repeated ischemic recurrence may eventually results in amputation. ......