Smoking Decay the Effects of Bilateral Femoro-popliteal Bypass Surgery

吸菸對雙側下肢動脈繞道手術的影響

10.6200/TCMJ.2012.9.4.10

盧崇弘(Lucifer Lu)

動脈硬化 ； 週邊動脈阻塞 ； 下肢動脈繞道手術 ； arthrosclerosis ； PAOD ； femoro-popliteal bypass

北市醫學雜誌

9卷4期（2012 / 12 / 01）

406 - 411

英文

目的：動脈硬化是全身性的病變，危險因子。其中包括：高血壓、高血脂、糖尿病、抽煙、肥胖、年齡、低溫環境等等。案例報告呈現：醫療科技再進步，抽煙行為對肢端的血流灌注的影響，絕對是有不可逆的危害。病例報告：個案本身88歲男性，既往病史包括高血壓，糖尿病，冠狀動脈疾症均長期接受藥物治療，唯有抽煙始終無法戒除，個案在接受整個療程中（手術前，手術後及保守治療）的報告數據包括動脈儀-踝肱指標及核磁共震動脈造影等臨床資料，顯示抽煙行為對下肢循環的影響。結論：個案的臨床變化，讓我們必須要強調的是：抽煙行為不僅是週邊動脈硬化的危險因子，雖然給予患者各種有效改善週邊血流的處置（不論是保守治療手術繞道血管內氣球擴張或支架），抽煙行為絕對有其積極戒除的必要。

Objective: Arthrosclerosis results in poor distal limbs perfusion and smoking is a well known risk factor that is associated with formation of arthroma affecting the blood vessel walls. We present here a case involving recurrent attacks of blue toes and intermittent claudication that occurred 2 years after femoro-popliteal bypass surgery. Case Report: The patient was an 88 years old, male who was suffering from blue toes and intermittent claudication. He had undergone bilateral femoro-politeal bypass surgery, but had continued to smoke after surgery. Clinical data obtained by MRA and ABI revealed that there significant worsening of the patient's distal perfusion and that the efficiency of the bypass had decreased measurably. Conclusion: In this case, we want to emphasize on that, even though medication and/or surgery intervention is able to improve ischemic limbs blood perfusion to some degree, if the patient continues to smoke, then the efficiency of the surgery and of any medication declines.