Extra-anatomic Arterial Bypass Grafting In The Treatment Of Vascular Surgery

Objectives : To study the clinical effect of extra-anatomic arterial bypass grafting in the treatment of vascular surgery.Methods: 1. We retrospectively analysed 52 patients who got the lower extremity atherosclerotic occlusive disease and underwent extra-anatomic arterial bypass grafting between October 2003 and March 2011 in our hospital. The cases included 41 male and 11 female, the age was from 30 to 87 yeas old, and the mean age was 73.1±6.2 years. Clinical Fontaine features included claudication 4,resting pain 32 and ulcer/gangrene 16 patients. All the 52 patients's anterior and posterior tibial artery pulse cann't be felt. The ABI (anke/brachial index) was 0.13 ~ 0.66, mean: 0.39±0.12. Axillofemoral bypass was performed in 21 cases, femoro-contralateral popliteal bypass in 17 cases and femorofemoroal bypass in 14 cases. In the cases there were 22 patients combined with hypertension, 21 patients with diabetes mellitus, 2 patients with coronary atery disease. 3 patients with old myocardial infarction., 4 patients with cerebral thrombosis. Compare the ABI measured before the operations and after the operations to evaluate the effect. 2. We retrospectively analysed 5 patients who got the abdominal aortic and iliac arteria aneurysm in our hospital from 2008, at the same time, All the patients'right and left iliac artery were seriously tortuous. The 5 patients included 4 male and 1 female, the age was from 61 to 83 yeas old, and the mean age was 74.2±5.6 years. All the 5 patients combined with hypertension and 3 patients with hyperlipoidemia, 2 patients with coronary atery disease. All the patients underwent the endovascular aortic aneurysm repair (EVAR) and femorofemoroal bypass grafting, We use the Doppler ultrasound apparatus to detect the bloodstream of the lower extremity after operation to evaluate the effect of extra-anatomic arterial bypass grafting in the treatment.Results: 1. All the 52 patients who got the lower extremity atherosclerotic occlusive disease could bear the operations, no patient dead in the perioperative period. The mean ABI measured 2 days after the treatmeng increased significantly from 0.39±0.12 to 0.87±0.11 perioperatively (P<0.05). Postoperatively, clinical features were relieved in 50 cases. Forty-one cases were followed up for 1 year, the overall graft patency rate was 92.6% (38/41). The number of days in hospital were 7-21d, mean: 11.4±2.68d. 2. After the treatment the 5 patients who got the abdominal aortic aneurysm didn't got serious complication and no patients dead. The temperature of the skin of the lower extremity was normal, the pules of the lower ertremity's artery were strong. Using the Doppler ultrasound apparatus to detect the bloodstream in the lower extremity after operation, it showed the bloodstream of the lower extremity was normal. The effective rate of the operations was 100%. The number of days in hospital were 9-17d, mean: 12.3±2.3d.Conclusion: 1.The extra-anatomic arterial bypass grafting in the treatment of he lower extremity atherosclerotic occlusive disease was effective, which has merits such as less invasive and less serious complication and rapid postoperative recovery. For the kind of feeble patients who can't tolerate normal anatomic arterial bypass grafting and endovascular repair in the treatment of vascular surgery, it provides a surgical treatment chance. 2. The extra-anatomic arterial bypass grafting was effective in the treatment of abdominal aortic aneurysm(AAA) combinded with the right and left iliac arterial aneurysm and with the right and (or) left iliac artery seriously tortuous, it also has merits such as less invasive and serious complication and rapid postoperative recovery. Moreover it is very valuable for the kind of patients who cann't tolerate the ectomy of abdominal aortic aneurysm because of febble body and the patients who get acute abdominal aortic aneurysm.