腘动脉陷迫综合征10例外科诊治分析
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摘要
目的总结腘动脉陷迫综合征的诊断及治疗经验。方法回顾性分析吉林大学中日联谊医院2012年1月至2018年7月期间诊治的10例(10条肢体)腘动脉陷迫综合征患者的临床资料。结果 10例腘动脉陷迫综合征患者中初诊症状7例为间歇性跛行,3例为急性下肢动脉缺血。9例术前超声和(或)计算机体层摄影血管造影均见腘动脉闭塞(6例明确诊断),其中7例行自体大隐静脉间位移植术,1例行腘动脉人工血管移植重建,1例行腘动脉取栓术后3 d闭塞而再次手术探查明确诊断后行股-腘动脉人工血管移植重建;另外1例入院后行数字减影血管造影后直接行置管溶栓和球囊扩张术后效果不佳而再次术中明确诊断后行肌束切除加腘动脉补片成形术。10例术后彩色多普勒超声随访3～12个月,1例自体大隐静脉间位移植远端吻合口端侧吻合重建患者术后1个月闭塞,1例腘动脉人工血管移植重建患者术后3个月闭塞,其余8例患者均通畅。结论手术治疗是腘动脉陷迫综合征唯一有效的根治治疗方式,完全闭塞病变采用自体大隐静脉间位移植重建的通畅率较高。
Objective To summarize experience of diagnosis and surgical treatment of popliteal artery entrapment syndrome(PAES). Method The clinical data of 10 patients(10 limbs) with PAES underwent surgery in the China-Japan Hospital of Jilin University from January 2012 to July 2018 were retrospectively analyzed. Results Among10 cases of PAES, 7 cases were firstly diagnosed with the intermittent claudication, 3 cases had presented the acute lower extremity ischemia. The preoperative ultrasound and(or) computed tomography angiography showed that 9 cases were all the popliteal artery occlusion and the digital subtraction angiography(DSA) was performed in 1 patient after the admission for the treatment. Six patients were preoperatively diagnosed with the PAES. Seven cases were treated with the autologous saphenous vein interstitial bypass; 1 case was occluded on day 3 after the popliteal artery thrombectomy, then the reconstruct of femoral popliteal artery was performed after the exploration and diagnosis. One case directly received the catheter thrombolysis and balloon dilatation during the process of DSA examination, the effect was not good, then the muscular bundle resection and popliteal artery artificial patch plasty was performed after confirming the PAES. All the 10 cases were followed up by the color doppler ultrasound after the surgery, 1 patient underwent the saphenous vein graft reconstruction(distal anastomotic anastomosis) was obliterated on month 1 after the surgery, 1 case was occluded on month 3 after the popliteal artery reconstruction, the patency rate of the remaining 8 patients was 100% from 3-month to1-year of following-up. Conclusion Surgical treatment is an only effective radical treatment of PAES and its patency rate of total occlusive lesions with autogenous saphenous vein graft is higher.
Objective To summarize experience of diagnosis and surgical treatment of popliteal artery entrapment syndrome(PAES). Method The clinical data of 10 patients(10 limbs) with PAES underwent surgery in the China-Japan Hospital of Jilin University from January 2012 to July 2018 were retrospectively analyzed. Results Among10 cases of PAES, 7 cases were firstly diagnosed with the intermittent claudication, 3 cases had presented the acute lower extremity ischemia. The preoperative ultrasound and(or) computed tomography angiography showed that 9 cases were all the popliteal artery occlusion and the digital subtraction angiography(DSA) was performed in 1 patient after the admission for the treatment. Six patients were preoperatively diagnosed with the PAES. Seven cases were treated with the autologous saphenous vein interstitial bypass; 1 case was occluded on day 3 after the popliteal artery thrombectomy, then the reconstruct of femoral popliteal artery was performed after the exploration and diagnosis. One case directly received the catheter thrombolysis and balloon dilatation during the process of DSA examination, the effect was not good, then the muscular bundle resection and popliteal artery artificial patch plasty was performed after confirming the PAES. All the 10 cases were followed up by the color doppler ultrasound after the surgery, 1 patient underwent the saphenous vein graft reconstruction(distal anastomotic anastomosis) was obliterated on month 1 after the surgery, 1 case was occluded on month 3 after the popliteal artery reconstruction, the patency rate of the remaining 8 patients was 100% from 3-month to1-year of following-up. Conclusion Surgical treatment is an only effective radical treatment of PAES and its patency rate of total occlusive lesions with autogenous saphenous vein graft is higher.
引文
1 Dyer KT, Hogrefe CP. Don't just blame it on the veins:an update on vascular exertional limb pain. Curr Sports Med Rep, 2018,17(10):347-353.
2刁永鹏,李拥军.累及胭动脉病变的治疗策略.中国普外基础与临床杂志,2014, 21(4):507-509.
3 di Marzo L, Cavallaro A. Popliteal vascular entrapment. World J Surg, 2005, 29 Suppl 1:S43-S45.
4 Lejay A, Ohana M, Lee JT, et al. Popliteal artery entrapment syndrome. J Cardiovasc Surg(Torino), 2014, 55(2 Suppl 1):225-237.
5 Rosset E, Hartung O, Brunet C, et al. Popliteal artery entrapment syndrome. Anatomic and embryologic bases, diagnostic and therapeutic considerations following a series of 15 cases with a review of the literature. Surg Radiol Anat, 1995, 17(2):161-27.
6 Hislop M, Kennedy D, Cramp B, et al. Functional popliteal artery entrapment syndrome:poorly understood and frequently missed?A review of clinical features, appropriate investigations, and treatment options. J Sports Med(Hindawi Publ Corp), 2014, 2014:105953.
7 Di Alencar TA, de Sousa Matias KF, de Sousa Matias KF. Lower limb vascular dysfunction in cyclists. J Vasc Bras, 2013,12(2):139-150.
8 Gourgiotis S, Aggelakas J, Salemis N, et al. Diagnosis and surgical approach of popliteal artery entrapment syndrome:a retrospective study. Vasc Health Risk Manag, 2008, 4(1):83-88.
9 Gaunder C, McKinney B, Rivera J. Popliteal artery entrapment or chronic exertional compartment syndrome? Case Rep Med, 2017,2017:6981047.
10 Levien LJ, Veller MG. Popliteal artery entrapment syndrome:more common than previously recognized. J Vasc Surg, 1999, 30(4):587-598.
11 Altinsoy HB, Alatas O, Khalil E, et al. A very rare cause of lower limb ischemia in young people:popliteal artery entrapment. Open Cardiovasc Med J, 2018, 12:18-28.
12 Iwaki R, Ozaki N, Tanaka Y, et al. Bilateral popliteal artery entrapment syndrome with asynchronous onset. Interact Cardiovasc Thorac Surg, 2011, 13(4):429-431.
13 Ozkan U, Oguzkurt L, Tercan F, et al. MRI and DSA findings inpopliteal artery entrapment syndrome. Diagn Interv Radiol, 2008,14(2):106-110.
14 Boniakowski AE, Davis F, Campbell D, et al. Intravascular ultrasound as a novel tool for the diagnosis and targeted treatment of functional popliteal artery entrapment syndrome. J Vasc Surg Cases Innov Tech, 2017, 3(2):74-78.
15 Ali AM, Ramos CR, Glebova NO. Suprageniculate approach to release of popliteal entrapment without distal bypass despite preoperative runoff thrombosis. Ann Vasc Surg, 2018,46:206.
16 Hicks CW, Black JH 3rd, Ratchford EV. Popliteal artery entrapment syndrome. Vasc Med, 2019,24(2):190-194.
17 Sinha S, Houghton J, Holt PJ, et al. Popliteal entrapment syndrome. J Vasc Surg, 2012, 55(1):252-262.
18 Hislop M, Brideaux A, Dhupelia S. Functional popliteal artery entrapment syndrome:use of ultrasound guided Botox injection as a non-surgical treatment option. Skeletal Radiol, 2017, 46(9):1241-1248.
19 Tercan F, Oguzkurt L, Kizilkilic O, et al. Popliteal artery entrapment syndrome. Diagn Interv Radiol, 2005,11(4):222-224.
20 Marzo L, Cavallaro A, Mingoli A, et al. Popliteal artery entrapment syndrome:the role of early diagnosis and treatment. Surgery, 1997,122(1):26-31.
21 White JM, Golarz SR, White PW, et al. Intraoperative duplex ultrasound criteria for performing interposition bypass in the treatment of popliteal artery entrapment syndrome. Ann Vasc Surg, 2015, 29(1):124.
22 Dovell G, Hinchliffe RJ. Surgery for popliteal artery entrapment syndrome:use of an intraoperative tibial nerve stimulator and duplex ultrasound. Ann R Coll Surg Engl, 2018,100(1):78-79.
23 Meier TO, Schneider E, Amann-Vesti B. Long-term follow-up of patients with popliteal artery entrapment syndrome treated by endoluminal revascularization. Vasa, 2010, 39(2):189-195.
24 Kim SY, Min SK, Ahn S, et al. Long-term outcomes after revascularization for advanced popliteal artery entrapment syndrome with segmental arterial occlusion. J Vasc Surg, 2012,55(1):90-97.
25 Igari K, Sugano N, Kudo T, et al. Surgical treatment for popliteal artery entrapment syndrome. Ann Vasc Dis, 2014,7(1):28-33.
26 Lejay A, Delay C, Georg Y, et al. Five year outcomes of surgical treatment for popliteal artery entrapment syndrome. Eur J Vasc Endovasc Surg, 2016, 51(4):557-564.
2刁永鹏,李拥军.累及胭动脉病变的治疗策略.中国普外基础与临床杂志,2014, 21(4):507-509.
3 di Marzo L, Cavallaro A. Popliteal vascular entrapment. World J Surg, 2005, 29 Suppl 1:S43-S45.
4 Lejay A, Ohana M, Lee JT, et al. Popliteal artery entrapment syndrome. J Cardiovasc Surg(Torino), 2014, 55(2 Suppl 1):225-237.
5 Rosset E, Hartung O, Brunet C, et al. Popliteal artery entrapment syndrome. Anatomic and embryologic bases, diagnostic and therapeutic considerations following a series of 15 cases with a review of the literature. Surg Radiol Anat, 1995, 17(2):161-27.
6 Hislop M, Kennedy D, Cramp B, et al. Functional popliteal artery entrapment syndrome:poorly understood and frequently missed?A review of clinical features, appropriate investigations, and treatment options. J Sports Med(Hindawi Publ Corp), 2014, 2014:105953.
7 Di Alencar TA, de Sousa Matias KF, de Sousa Matias KF. Lower limb vascular dysfunction in cyclists. J Vasc Bras, 2013,12(2):139-150.
8 Gourgiotis S, Aggelakas J, Salemis N, et al. Diagnosis and surgical approach of popliteal artery entrapment syndrome:a retrospective study. Vasc Health Risk Manag, 2008, 4(1):83-88.
9 Gaunder C, McKinney B, Rivera J. Popliteal artery entrapment or chronic exertional compartment syndrome? Case Rep Med, 2017,2017:6981047.
10 Levien LJ, Veller MG. Popliteal artery entrapment syndrome:more common than previously recognized. J Vasc Surg, 1999, 30(4):587-598.
11 Altinsoy HB, Alatas O, Khalil E, et al. A very rare cause of lower limb ischemia in young people:popliteal artery entrapment. Open Cardiovasc Med J, 2018, 12:18-28.
12 Iwaki R, Ozaki N, Tanaka Y, et al. Bilateral popliteal artery entrapment syndrome with asynchronous onset. Interact Cardiovasc Thorac Surg, 2011, 13(4):429-431.
13 Ozkan U, Oguzkurt L, Tercan F, et al. MRI and DSA findings inpopliteal artery entrapment syndrome. Diagn Interv Radiol, 2008,14(2):106-110.
14 Boniakowski AE, Davis F, Campbell D, et al. Intravascular ultrasound as a novel tool for the diagnosis and targeted treatment of functional popliteal artery entrapment syndrome. J Vasc Surg Cases Innov Tech, 2017, 3(2):74-78.
15 Ali AM, Ramos CR, Glebova NO. Suprageniculate approach to release of popliteal entrapment without distal bypass despite preoperative runoff thrombosis. Ann Vasc Surg, 2018,46:206.
16 Hicks CW, Black JH 3rd, Ratchford EV. Popliteal artery entrapment syndrome. Vasc Med, 2019,24(2):190-194.
17 Sinha S, Houghton J, Holt PJ, et al. Popliteal entrapment syndrome. J Vasc Surg, 2012, 55(1):252-262.
18 Hislop M, Brideaux A, Dhupelia S. Functional popliteal artery entrapment syndrome:use of ultrasound guided Botox injection as a non-surgical treatment option. Skeletal Radiol, 2017, 46(9):1241-1248.
19 Tercan F, Oguzkurt L, Kizilkilic O, et al. Popliteal artery entrapment syndrome. Diagn Interv Radiol, 2005,11(4):222-224.
20 Marzo L, Cavallaro A, Mingoli A, et al. Popliteal artery entrapment syndrome:the role of early diagnosis and treatment. Surgery, 1997,122(1):26-31.
21 White JM, Golarz SR, White PW, et al. Intraoperative duplex ultrasound criteria for performing interposition bypass in the treatment of popliteal artery entrapment syndrome. Ann Vasc Surg, 2015, 29(1):124.
22 Dovell G, Hinchliffe RJ. Surgery for popliteal artery entrapment syndrome:use of an intraoperative tibial nerve stimulator and duplex ultrasound. Ann R Coll Surg Engl, 2018,100(1):78-79.
23 Meier TO, Schneider E, Amann-Vesti B. Long-term follow-up of patients with popliteal artery entrapment syndrome treated by endoluminal revascularization. Vasa, 2010, 39(2):189-195.
24 Kim SY, Min SK, Ahn S, et al. Long-term outcomes after revascularization for advanced popliteal artery entrapment syndrome with segmental arterial occlusion. J Vasc Surg, 2012,55(1):90-97.
25 Igari K, Sugano N, Kudo T, et al. Surgical treatment for popliteal artery entrapment syndrome. Ann Vasc Dis, 2014,7(1):28-33.
26 Lejay A, Delay C, Georg Y, et al. Five year outcomes of surgical treatment for popliteal artery entrapment syndrome. Eur J Vasc Endovasc Surg, 2016, 51(4):557-564.
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