下肢外伤性动静脉瘘的诊治体会（附5例报告）

摘要

From May 2009 to February 2012, five patients with traumatic lower limb arteriovenous fistula were admitted in our department .Four patients underwent endovascular stent grafting , and one patient was given fistula indwelling , deep femoral artery-superficial femoral artery end to side anastomosis , and femoral artery-superficial femoral artery artificial vescular grafting .Four patients were cured, which were followed for 3, 5, 3, and 3 years, respectively, without recurrence.One patient with endovascular stent grafting failed to isolate the fistula effectively and a second stent grafting failed , too.Endovascular stent grafting is an effective method in the treatment of fistula, with less bleeding, small trauma, and rapid recovery.By using the technology of "through the hills"to isolate limb fistula, the covered stent might not be released when the fistula is located at low position and at the same time the left iliac artery bifurcation angle is small .%2009年5月～2012年2月我科收治5例下肢外伤性动静脉瘘，4例行腔内覆膜支架隔绝瘘口，1例行瘘口旷置＋股深动脉-股浅动脉端侧吻合＋股总动脉-股浅动脉人工血管移植术。4例分别随访3、5、3、3年，无复发；1例腔内治疗时第1枚覆膜支架未能有效隔绝瘘口，再次释放第2枚支架时未能成功，随访2年，左下肢、会阴部肿胀，色素沉着呈逐渐加重趋势。腔内覆膜支架隔绝瘘口是可靠的治疗方法，出血少、创伤小、恢复快。通过翻山技术隔绝对侧肢体瘘口，当瘘口位置较低，同时左右髂动脉分叉角度较小时，有无法成功释放覆膜支架的可能。