内膜下再通术治疗外周动脉完全闭塞性病变  

Subintimal recanalization for peripheral artery total occlusion

作　　者：李京雨[1] 于建[2] 张强[1] 刘涛[1] 徐力扬[1] 

机构地区：[1]北京军区总医院放射科,100700 [2]北京军区总医院血管外科,100700

出　　处：《中华放射学杂志》2007年第12期1379-1383,共5页Chinese Journal of Radiology

摘　　要：目的探讨内膜下再通技术(SIR)治疗外周动脉粥样硬化闭塞病变的技术要点和疗效。方法使用内膜下再通技术治疗18例患者的20处外周动脉完全闭塞病变。闭塞病变分别位于下肢动脉(髂股动脉14处、膝以下动脉4处)和左锁骨下动脉(2处)。内膜下再通的基本操作步骤:血管造影后导管抵近闭塞动脉近端,使用直径0.035 in(1 in=2.54 cm)的 TERUMO 超滑导丝,穿通动脉内膜后在闭塞段动脉内膜下腔中前行,通过闭塞段后重入动脉真腔。建立闭塞段动脉内膜下通道后使用球囊扩张成形。除膝以下动脉和1处髂动脉之外,均在开通的内膜下通道起始部或全程置放自膨式支架。结果 15例患者的17处病变内膜下再通治疗获得成功,临床症状显著改善。无动脉穿孔、血栓形成或动脉粥样硬化斑块脱落栓塞等并发症。3例技术失败患者临床症状无变化,失败原因分别是导丝不能重入内膜真腔和内膜下腔,扩张成形不满意。结论内膜下再通技术治疗外周动脉闭塞病变可行性强、疗效显著、安全性良好、技术相对简便;在治疗比较复杂的动脉闭塞病变时是传统经皮血管腔内成形术(PTA)的重要补充手段。Objective To assess the technique and clinical outcome of subintimal recanolization （SIR） for peripheral artery total occlusion. Methods Eighteen patients with 20 arterial occlusions underwent SIR. The occlusive lesions were located in the iliac-femoral artery （ 14 lesions）, the infrapopliteal arteries （4 lesions） and the left subclavian artery （2 lesions） ,respectively. Basic procedure of SIR was to create a subintimal path in the wall of the occluded artery and reentry the true lumen by using 0. 035 inch diameter TERUMO guidwire and angiographic catheter. Subsequently, balloon angioplasty was performed in all recanalized lesions, and stent was placed in initial parts or whole recanalized path except one lesion in the lilac-femoral artery, and the lesions in the infrapopliteal arteries. Results Seventeen occlusive lesions in 15 patients were successfully recanalized by means of SIR, and the corresponding symptoms were disappeared or improved obviously. Technical failure occurred in 3 patients due to inability to reenter the distal true lumen or balloon angioplasty was not satisfactory. No complications of artery rupture, thrombosis or embolization were found. Conclusion SIR is an effective and safe therapy for peripheral artery total occlusion. This technique provides a feasible alternative to conventional percutaneous transluminal angioplasty especially in the complicated cases.

关 键 词：动脉硬化 闭塞性 髂动脉 锁骨下动脉 放射学 介入性 

分 类 号：R654.3[医药卫生—外科学]