Application and observation on the treatment of lower extremity arteriosclerosis occlusion by constructing collateral vessels with muscle flap during femoral popliteal artery artificial vascular bypass
Hu Jiqiong, Xue Qingquan, Liang Shuangchao
Department of Vascular Surgery, Yijishan Hospital of Wannan Medical College, Wuhu 241001, China
Abstract：Objective To investigate the compensatory effect of perigenicular muscle flap construction during femoral popliteal artery artificial vascular bypass on subgenicular blood supply in patients with arteriosclerotic occlusive disease (ASO). Methods In this retrospective descriptive study, 31 ASO patients were selected from the Vascular Surgery Department of Yijishan Hospital, which is affiliated to Wannan Medical College, from June 2012 to July 2020 for inclusion. All patients, including 22 males and 9 females aged 52-87 (72.3±3.6) years old, had unilateral limb lesions. Their Rutherford stage was 3 or above, and ankle-brachial index (ABI) was 0.32±0.13. Eight cases had diabetes, 14 cases had hypertension, and 9 cases had hypertension and diabetes. All patients were treated with femoral popliteal artery artificial vascular bypass, in which the severed medial head of the gastrocnemius was sutured with imbricate sutures of ipsilateral semimembrane, semitendinosus, and sartorius muscles. Collateral vessels were constructed with perigenicular muscle flaps. After surgery, the artificial blood vessel occlusion (no blood flow signal) was examined by ultrasound, and the limb ischemia of the patient was observed. Meanwhile, ABI before and after operation was observed and compared. The amputation rate of the patient was measured, and the living status of the patients with successful limb salvage was observed. Result All 31 patients successfully completed the operation with no perioperative death. ABI at 1 week after surgery was (0.58±0.19), which was higher than that before surgery (0.32±0.13), and the difference was statistically significant (t=3.02, P=0.002). Postoperative follow-up lasted from 6 months to 60 months, with an average of 24.6 months. Although the patient had transient ischemia symptoms after the occlusion of artificial blood vessels, he recovered via anticoagulation treatment and functional exercise. Two patients died of myocardial infarction at 2 and 24 months after surgery respectively, and another died of cerebral infarction 3 years after the surgery. All patients had no resting pain symptoms of the lower limbs and were able to perform indoor activities. Two cases underwent amputation 6 and 15 months after operation due to the multiple segmental occlusion of deep femoral artery and insufficient blood supply to subgenicular tissue. The remaining 26 patients' limb salvage was successful without clinical re-intervention and no resting pain. Conclusion In ASO patients treated with femoral popliteal artery bypass, the symptoms of lower limb ischemia were aggravated after artificial vascular occlusion. In this group of patients, gastrocnemius muscle flap was used to construct collateral vessels around the knee, and no significant aggravation of lower limb ischemia was observed after occlusion of artificial vessels. This finding indicated that muscle flap construction has a certain effect on the alleviation of the ischemic state of the patients' lower knee limbs.
胡骥琼, 薛清泉, 梁双超. 股腘动脉人工血管旁路术中膝周肌瓣构建侧支血管在下肢动脉硬化闭塞症治疗中的应用与观察[J]. 中华解剖与临床杂志, 2022, 27(7): 502-506.
Hu Jiqiong, Xue Qingquan, Liang Shuangchao. Application and observation on the treatment of lower extremity arteriosclerosis occlusion by constructing collateral vessels with muscle flap during femoral popliteal artery artificial vascular bypass. Chinese Journal of Anatomy and Clinics, 2022, 27(7): 502-506.
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2022, Vol. 27 
