In Situ Great Saphenous Vein Bypass For The Treatment Of Fontaine Ⅲ,Ⅳ Arteriosclerosis Obliterans

Background: Arteriosclerosis Obliterans of lower extremity(ASO) is a common, frequently-occurring disease. Since 1891, von Mantenfel first found limbs arteriosclerosis obliterans caused necrosis, the medical profession began to giving more attention about this disease. Lower extremity arterial occlusive disease is a degenerative disease, the mainly pathological changes are cells, fibrous matrix, lipid abnormalities and organizations debris deposition in the arterial and intimal hyperplasia or happened in the middle which eventually lead to wall thickening, luminal stenosis, occlusive. With the development of society, the standard people's living improving, the change in diet, people's aging process, as well as the development of the diagnosis and the treatment of vascular surgery. It's incidence is reported abroad is 11.6% to 24.6%, and the latest epidemiological survey in China showed that the people over 50 years who also have diabetes mellitus, the incidence of ASO can reach 19.47%.According to the severity of symptoms, there are four stages of the patients with atherosclerosis obliterans, and it is called Fontaine stages. I period: period of minor chief; II period: period of intermittent claudication; III period: period of rest pain; IV period: period of tissue necrosis. For the vast majority of FontaineI, II patients after conservative treatment and functional exercise, the symptoms will be significantly improved, for a long time, and the disease will be remained stable. The patients with FontaineIII,IV arteriosclerosis obliterans have clinical manifestations of severe rest pain, ulcers and limb necrosis, eventually leading to amputation, disability. The patients of III, IV arteriosclerosis obliterans often associated with high blood pressure, diabetes, heart disease and other diseases. Patients with serious hazards and reduce the patient's quality of life. The conservative treatment is longer, and it is difficult to correct limb ischemia, and easily repeated. At the same time , FontaineIII, IV period in patients with arteriosclerosis obliterans of lower extremity , arterial stenosis or occlusive is always multi-segmental and of many plane and the lesions often have distal patency of the outflow tract, which the patient's artery bypass implementation is possible. Therefore, FontaineIII, IV period in patients with clinical severe ischemia, according to the specific circumstances of patients, The use of surgery, interventional vascular surgery and other positive interventions is necessary.This article is a retrospective analysis of 28 cases of patients who have Fontaine III,IV arteriosclerosis obliterans in our hospital underwent in situ saphenous vein bypass surgery methods from January 2007 to March 2009, and achieved good results.Objective To evaluate the result of in situ great saphenouse vein bypass for the treatment of Fontaine III,IV arteriosclerosis obliterans of lower limb ischemia. Methods From 2007 to 2009, 28 patients with Fontaine III,IV arteriosclerosis obliterans of lower limb ischemia underwent in situ great saphenouse vein bypass using THE BUSHTM valvulotome in our hospital. And at the same time Some cases underwent endarterectomy of the outflow, balloon-expandable stent and os on. The distal anastomosis was made on posterior tibial artery in 19 cases, anterior tibial artery in 3 cases, dorsalis pedis artery in 3 cases, posterior tibial vein in 1 cases, saphenous vein arterialization in 2 cases.Results All cases of postoperative symptoms are alleviated, 26 cases of the rest pain disappeared, skin temperature significantly increased, ulcer healing, and with clear boundaries between necrosis and normal tissue. With average ankle/brachial index changin from 0.32(0～0.58) preoperatively to 0.78(0.48～0.93)postoperatively. The cumulative patency rate at 6,12and 24 monthes were 92.86%,85.72%,78.58%, respectively. Conclusion In situ saphenous vein bypass combined with endarterectomy, interventional surgical treatment of the hybrid vascular surgery is the direction of development. In situ great saphenouse vein bypass is effective for the treatment of Fontaine III,IV arteriosclerosis obliterans of lower limb ischemia. Especially those who with long-range multi-segment multi-planar artery of lower extremety of Fontaine III,IV arteriosclerosis obliterans.