The application of popliteal vein anatomy study and valve construction procedure / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze anatomy data of popliteal veins (PV), with the purpose of selection of popliteal venous valves construction segment via venography, and to evaluate the surgical results.</p><p><b>METHODS</b>From February 1998 to November 2010, after analyzing the popliteal vessel anatomy data of 39 limbs and related phlebography research of 862 cases, 102 patients (69 male and 33 female patients, aged from 48 to 71 years, mean 59 years) with severe deep venous insufficiency were selected for popliteal venous valve construction procedures. Doppler ultrasound, continuous dynamic venography, and intraoperative venous pressure measurements were used to assess the hemodynamic changes pre- and postoperatively. Venous clinical severity score (VCSS) were used to evaluate long-term results of deep venous valve construction procedures.</p><p><b>RESULT</b>In the 102 patients, 93.7% patients had one pair of valves in popliteal vein (PV), locating in the distal 1/3 segment of PV, with gastrocnemius veins (GV) joining with PV above PV valves. Postoperative blood flow volume of the PV was significantly higher than the preoperative volume (732.3 ml/min vs. 150.2 ml/min, t = 8.979, P < 0.001). The proximal pressure was significantly lower than the distal pressure ((12 ± 3) cm H(2)O vs. (15 ± 3) cm H(2)O, 1 cm H(2)O = 0.098 kPa, t = 8.049, P < 0.001). VCSS score was significantly lower after the surgery ((34 ± 15) cm H(2)O vs. (41 ± 14) cm H(2)O, t = 59.780, P < 0.001). Pre- and postoperative hemodynamic changes and VCSS scores were statistically significant (9.3 ± 1.9 vs. 1.8 ± 1.0, t = 59.780, P < 0.001). Mean follow-up were 8.9 years with an ulcer recovery rate of 96.3%, and a 3.7% ulcer recurrent rate.</p><p><b>CONCLUSIONS</b>Popliteal vessel anatomy study and venography research provide critical information for the PV valve construction part selection, which stayed proximal to the communications of GV and PV. Restoration of gastrocnemius pump function and satisfactory long-term efficacy are received after valve construction.</p>

Treatment of long-segment iliofemoral occlusive disease: two extra-anatomic bypass surgeries / 中华外科杂志

<p><b>OBJECTIVE</b>To report and evaluate the clinical results of surgical treatment for long-segment iliofemoral arteriosclerosis obliterans, including external iliac-popliteal (EIP) and femoral-deep femoral (FDF) crossover bypass surgeries.</p><p><b>METHODS</b>From July 1995 to December 2009, 85 patients (61 male, 24 female, aged from 64 to 91 years, mean age 75 years) with comprehensive unilateral iliac-superficial femoral arteriosclerosis obliterans were involved in this research. According to Fontaine classification, the 85 patients could be graded as 62 class IIb-III patients (72.9%), and 23 class IV patients (27.1%). In CT angiography or DSA examinations, the 85 patients were grouped into EIP (n = 49) and FDF (n = 36) surgical groups on the basis of visualizations in the affected deep femoral, supra-knee/infra-knee popliteal arteries. The healing time of ulcers and toe amputation wound, ankle-brachial index, and blood flow velocity in the affected limb together with accumulative patency rates in 1, 3 and 5 years and limb salvage rates in 3 and 5 years were analyzed.</p><p><b>RESULTS</b>None of the 85 patients died or had extremity amputated in perioperatively. Seventy-four patients (87.1%) had been followed up from 2 to 13 years (mean 5.7 years). Postoperative ankle-brachial index of FDF and EIP groups was 0.55 ± 0.11, and 0.94 ± 0.13 (t = -21.88, P = 0.000). Postoperative velocity of popliteal artery blood flow in FDF and EIP groups was (32 ± 9) cm/s, and (48 ± 4) cm/s (t = 16.76, P = 0.000); velocity of anterior or posterior tibial artery was (22 ± 7) cm/s, and (42 ± 4) cm/s (t = 10.50, P = 0.000). The primary and secondary patency rates of FDF and EIP groups were 87.8% and 88.3%, 80.7% and 81.2%, 68.4% and 57.4% at 1, 3 and 5 years, respectively. Limb salvage rates of FDF and EIP groups were 87.6% and 88.6%, 76.7% and 71.3%, at 3 and 5 years, respectively. There were no statistically significant differences in 1, 3, and 5 years' cumulative secondary patency rate and limb salvage rate between FDF and EIP groups.</p><p><b>CONCLUSIONS</b>As extra-anatomic bypass surgeries, FDF and EIP are both determined to be alternative procedures for unilateral common iliac-superficial femoral artery occlusive disease, especially suitable for high-risk patients. EIP group patients have better clinical outcomes than those in FDF group.</p>