Application of femoral-femoral artery bypass grafting combined with transverse tibial bone transporting for lower extremity arteriosclerosis obliterans or combined with diabetic foot_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Bin , LIU Wei , HUO Yongxin , GONG Zhongping , WANG Wei , HAO Ruizheng , FANG Jun , ZHANG Jian , JIANG Wenping

Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China;

Corresponding?author：

WANG Bin, Email: wbladyp3@163.com

Keywords：

Arteriosclerosis obliterans; femoral artery; bypass; transverse tibial bone transporting

DOI：

10.7507/1002-1892.201806124

Video：

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ObjectiveTo discuss the effectiveness of femoral-femoral artery bypass grafting combined with transverse tibial bone transporting in treatment of lower extremity arteriosclerosis obliterans (ASO) or combined with diabetic foot. MethodsBetween March 2014 and June 2016, 9 patients with lower extremity ASO or combined with diabetic feet were treated with femoral-femoral artery bypass grafting and transverse tibial bone transporting. All patients were male, aged from 63 to 82 years with an average of 74.2 years. The disease duration of ASO was 1.5-22.0 months (mean, 10.5 months). All cases were severe unilateral iliac arterial occlusion, including 5 cases of the left side and 4 cases of the right side. There were 7 cases with superficial femoral and/or infrapopliteal artery disease. There were 7 cases of ASO and 2 cases of ASO combined with diabetic foot (Wagner grade 4); all the ASO were grade Ⅳ according to Fontaine criteria. All patients had rest pain before operation, and the ankle brachial index was 0.24±0.12. In femoral-femoral artery bypass grafting operations, artificial blood vessels were used in 7 cases and autologous saphenous vein were used in the other 2 cases. The tibial bone transverse transporting began on the 8th day after operation by 1 mm per day and once per 6 hours; after transported for 2-3 weeks, it was moved back. The whole course of treatment was 10-14 weeks. ResultsThe incision of tibial bone transverse transporting was necrotic in 1 case, and healed after dressing change. There was no obvious complication at the orifice of the needle. The other patients had no incision complication. The granulation tissue of foot wound was growing quickly after tibial bone transverse transporting, and the wound was reduced after 2-3 weeks. All the 9 patients were followed up 12-32 months (mean, 19 months). The ankle brachial index was 0.67±0.09 at 2 months postoperatively, which was significantly higher than that before operation (t=17.510, P=0.032). All the feet ulcer wounds healed and the healing time was 6.7-9.4 weeks (mean, 7.7 weeks). During follow-up, color Doppler ultrasound or CT examination revealed grafted blood vessel patency. The external fixator was removed at 12-14 weeks after operation. One case died of sudden myocardial infarction at 14 months after operation, and there was no lymphatic leakage. The patency rate of femoral-femoral bypass was 100% at 1 year after operation. The tibial transverse bone grafting healed with tibia at 4-6 months after operation. At last follow-up, the effective rate was 100%. ConclusionFemoral-femoral artery bypass grafting combined with transverse tibial bone transporting is an effective method in the treatment of lower extremity ASO or combined with diabetic foot.

Citation： WANG Bin, LIU Wei, HUO Yongxin, GONG Zhongping, WANG Wei, HAO Ruizheng, FANG Jun, ZHANG Jian, JIANG Wenping. Application of femoral-femoral artery bypass grafting combined with transverse tibial bone transporting for lower extremity arteriosclerosis obliterans or combined with diabetic foot. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1576-1580. doi: 10.7507/1002-1892.201806124 Copy

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11.	Mammoto A, Connor KM, Mammoto T, et al. A mechanosensitive transcriptional mechanism that controls angiogenesis. Nature, 2009, 457(7233): 1103-1108.
12.	Yang L, Nayagam S, Saleh M. Stiffness characteristics and interfragmentary displacements with different hybrid external fixators. Clin Biomechl, 2003, 18(2): 166-172.
13.	Mammoto A, Connor KM, Mammoto T, et al. A mechanosensitive transcriptional mechanism that controls angiogenesis. Nature, 2009, 457(7233): 1103-1108.
14.	Hu J, Zou S, Li J, et al. Temporospatial expression of vascular endothelial growth factor and basic fibroblast growth factor during mandibular distraction osteogenesis. J Craniomaxillofac Surg, 2003, 31(4): 238-243.
15.	Kaspar D, Neidlinger-Wilke C, Holbein O, et al. Mitogens are increased in the systemic circulation during bone callus healing. J Orthop Res, 2003, 21(2): 320-325.
16.	歐栓機, 齊勇, 孫鴻濤, 等. 經皮微創脛骨截骨橫向骨搬移術治療糖尿病足. 中國矯形外科雜志, 2018, 26(15): 1385-1389.
17.	賈中偉, 余建平, 蘇云星, 等. 脛骨橫向骨搬移結合負壓引流治療糖尿病足潰瘍的臨床療效分析. 中國骨傷, 2018, 31(3): 232-236.
18.	冼呈, 趙勁民, 蘇偉, 等. 外固定架骨搬移系統修復糖尿病足: 功能與影像學評價. 中國組織工程研究, 2015, 19(46): 7539-7544.
19.	花奇凱, 秦泗河, 趙良軍, 等. Ilizarov 技術脛骨橫向骨搬移術治療糖尿病足. 中國矯形外科雜志, 2017, 25(4): 303-307.
20.	王斌, 楊漪舸. 股-股動脈旁路移植聯合脛骨橫向骨搬移術治療動脈硬化閉塞癥一例. 中國修復重建外科雜志, 2015, 29(9): 1194.

1. Halperin JL. Evaluation of patients with peripheral vascular disease. Thromb Res, 2002, 106(6): V303-V311.
2. 曲龍, 王愛林, 湯福剛. 脛骨橫向搬移血管再生術治療血栓閉塞性脈管炎. 中華醫學雜志, 2001, 81(10): 622-624.
3. 趙克強, 張小明, 沈晨陽, 等. 動脈旁路手術治療慢性下肢缺血的中遠期結果. 中華外科雜志, 2008, 46(12): 914-917.
4. Szilagyi DE, Elliott JP Jr, Smith RF, et al. A thirty-year survey of the reconstructive surgical treatment of aortoiliac occlusive disease. J Vasc Surg, 1986, 3(3): 421-436.
5. Cronenwett JL, Johnston KW. 盧瑟福血管外科學. 郭偉, 符偉國, 陳忠, 主譯. 7 版. 2013: 1623-1628.
6. 王培順, 黎洪浩, 羅定遠, 等. 股-股動脈人工學管轉流術 21 例臨床分析. 中國血管外科雜志 (電子版), 2012, 4(2): 93-94.
7. Rinckenbach S, Guelle N, Lillaz J, et al. Femorofemoral bypass as an alternative to a direct aortic approach in daily practice: appraisal of its current indications and midterm results. Ann Vasc Surg, 2012, 26(3): 359-364.
8. 朱云峰, 朱永斌, 王紅粉. 股深動脈血流重建治療下肢動脈硬化閉塞癥. 中華普通外科雜志, 2006, 21(7): 488-490.
9. 馬韜, 馬杰, 陸清聲, 等. 股-股深動脈人工血管旁路術治療單側長段髂股動脈硬化閉塞癥. 中華普通外科雜志, 2012, 27(11): 893-895.
10. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res, 1989, 238: 249-281.
11. Mammoto A, Connor KM, Mammoto T, et al. A mechanosensitive transcriptional mechanism that controls angiogenesis. Nature, 2009, 457(7233): 1103-1108.
12. Yang L, Nayagam S, Saleh M. Stiffness characteristics and interfragmentary displacements with different hybrid external fixators. Clin Biomechl, 2003, 18(2): 166-172.
13. Mammoto A, Connor KM, Mammoto T, et al. A mechanosensitive transcriptional mechanism that controls angiogenesis. Nature, 2009, 457(7233): 1103-1108.
14. Hu J, Zou S, Li J, et al. Temporospatial expression of vascular endothelial growth factor and basic fibroblast growth factor during mandibular distraction osteogenesis. J Craniomaxillofac Surg, 2003, 31(4): 238-243.
15. Kaspar D, Neidlinger-Wilke C, Holbein O, et al. Mitogens are increased in the systemic circulation during bone callus healing. J Orthop Res, 2003, 21(2): 320-325.
16. 歐栓機, 齊勇, 孫鴻濤, 等. 經皮微創脛骨截骨橫向骨搬移術治療糖尿病足. 中國矯形外科雜志, 2018, 26(15): 1385-1389.
17. 賈中偉, 余建平, 蘇云星, 等. 脛骨橫向骨搬移結合負壓引流治療糖尿病足潰瘍的臨床療效分析. 中國骨傷, 2018, 31(3): 232-236.
18. 冼呈, 趙勁民, 蘇偉, 等. 外固定架骨搬移系統修復糖尿病足: 功能與影像學評價. 中國組織工程研究, 2015, 19(46): 7539-7544.
19. 花奇凱, 秦泗河, 趙良軍, 等. Ilizarov 技術脛骨橫向骨搬移術治療糖尿病足. 中國矯形外科雜志, 2017, 25(4): 303-307.
20. 王斌, 楊漪舸. 股-股動脈旁路移植聯合脛骨橫向骨搬移術治療動脈硬化閉塞癥一例. 中國修復重建外科雜志, 2015, 29(9): 1194.

Chinese Journal of Reparative and Reconstructive Surgery

Application of femoral-femoral artery bypass grafting combined with transverse tibial bone transporting for lower extremity arteriosclerosis obliterans or combined with diabetic foot

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