经腘动脉入路逆行内膜下血管成形术治疗股浅动脉长段硬化性闭塞症临床对照研究  

Control Study of Retrograde Subintimal Angioplasty Via Popliteal Artery Access for Treatment of Long Occlusive Disease of Superficial Femoral Artery

作　　者：陆海华[1] 贾玉柱[1] 张玲芳[1] 曹玉林[1] 

机构地区：[1]浙江省立同德医院介入科,浙江杭州310012

出　　处：《中国现代医生》2011年第35期36-39,共4页China Modern Doctor

摘　　要：目的探讨经腘动脉入路逆行内膜下血管成形术治疗股浅动脉长段硬化性闭塞症的可行性和近期效果。方法回顾性分析17例因股浅动脉及腘动脉近端完全闭塞接受经腘动脉入路逆行内膜下血管成形术/支架置入术的患者,并选择同期24例因相似病变行常规入路内膜下血管成形术/支架置入术成功的患者与之相对照,两组TASC II分类构成比无统计学差异(P>0.05)。分析比较两组技术成功率、临床疗效、术中术后并发症发生情况。结果两组技术即时成功率均为100%。观察组术后6个月的初次通畅率为94.7%(16/17);12个月时初次通畅率为76.5%(13/17),再次通畅率100%。并发症(3例,17.6%)主要有腘动脉穿刺点假性动脉瘤,股动脉穿刺点出血,肢体远端动脉急性栓塞,根据情况给予了相应处理。ABI指数从术前的(0.43±0.23)上升至(0.89±0.26)(出院前),6个月(0.86±0.25)及12个月(0.81±0.23)时保持改善状态(P<0.01)。对照组术后6个月的初次通畅率为91.7%(22/24)1;2个月时初次通畅率为75.0%(18/24),再次通畅率100%。并发症2例(8.3%),均为术后当晚股动脉穿刺点出血,重新加压包扎处理。ABI指数从术前的(0.55±0.31)上升至(0.90±0.23)(出院前),6个月(0.88±0.21)及12个月(0.85±0.26)时保持改善状态(P<0.01)。两组间术后通畅率、ABI差异无统计学差异(P>0.05)。结论对于长段股浅动脉/腘动脉近端闭塞性病变,在腔内顺行开通失败的情况下运用经腘动脉入路逆行内膜下血管成形/支架置入术是一种安全有效的补救措施。Objective To study the feasibility and short term efficacy of retrograde subintimal angioplasty via popliteal artery access for treatment of long occlusive disease of superficial femoral artery. Methods A retrospective study was performed in 41 patients with !ong occlusive disease of superficial femoral artery （SFA） and/or proximal popliteal arteries （PA）. 17 cases （ as study group ） accepted rerograde subintimal angioplasty and endovascular stent implantation via popliteal artery access while the others （24 cases,as control group） accepted the same therapy only via routine artery access. The constituent ratio of TASC II type had no significant difference between the two groups（P〉0.05）. Procedural success rate,clinical efficacy,the complications were analyzed and compared. Results The technical success rate was 100% in all patients of both gorups. In study group,the primary patency were 94.7%（16/17）,76.5% （13/17） at 6 months and 12 months respectively,secondary patency was 100% at 12 months and three （17.6%）major complications occurred,including pseudoaneurysm of PA,bleeding at the femoral puncture site and acute embolism of distal limb artery,the ABI increased from 0.43 ±0.23 to 0.89±0.26 at discharge and remained improved at 6 （0.86 ±0.25） and 12months（0.81 ±0.23）（P〈0.01 ）. while in control group,the primary patency were 91.7%（22/24）,75.0%（18/24） at 6months and 12months respectively,secondary patency was 100% at 12months and 2 （8.3%） major complications of bleeding at the femoral puncture site occurred,the ABI increased from （0.55 ± 0.31 ） to （0.90 ± 0.23） at discharge and remained improved at 6 （0.88 ± 0.21 ） and 12months（0.85 ± 0.26）（P〈0.01 ）.The postoperative patency and the ABI had no significant difference between the two groups（P〉0.05）. Conclusion Failed antegrade attempts to recanalize long occlusive disease of the SFA and proximal PA can be salvaged using a retrograde popliteal access for subintimal angioplas

关 键 词：股浅动脉 动脉硬化闭塞症 血管成形术 内支架 逆行入路 腘动脉入路 并发症 

分 类 号：R543.5[医药卫生—心血管疾病]