股动脉顺行穿刺治疗下肢动脉闭塞性病变的临床效果观察  

Clinic effects of interventional treatment of lower extremity arterial occlusive disease with antegrade femoral artery puncture

作　　者：龙海灯[1] 殷世武[1] 项廷淼[1] 张慧林[1] 高宗根[1] 潘升权[1] 

机构地区：[1]安徽医科大学附属合肥医院,安徽230011

出　　处：《当代医学》2012年第6期17-20,共4页Contemporary Medicine

摘　　要：目的观察股动脉顺行穿刺和对侧逆行穿刺方法治疗下肢动脉闭塞性病变的优缺点。方法对33例下肢动脉闭塞性病变的患者共41条患肢,分为研究组17例共22条患肢与对照组16例共19条患肢,分别采用顺行股动脉穿刺技术及对侧逆行股动脉穿刺技术对患肢进行介入治疗。通过观察两种不同穿刺路径的并发症发生率、技术成功率、术后1W、1Mo及6Mo的患肢踝-肱指数(ABI)及彩超检查血流速度等相关指标评价两种不同穿刺路径对下肢动脉闭塞性病变治疗的优缺点。结果研究组出现穿刺部位渗血1例,并发症发生率为4.5%(1/22),1例病变血管远端无流出道未能开通、2例动脉硬化闭塞症的患者病程较长未能开通(患肢因病程较长未能达到PTA治疗成功标准),技术成功率86.4%(19/22);对照组3例因髂动脉扭曲导致导管出导管鞘处扭曲,导管进入对侧病变段困难、2例穿刺部位渗血、2例导管打折,并发症发生率为36.8%(7/19);2例因置入翻山鞘失败而未能成功行PTA术、2例因导管跨越髂动脉路径长而导致导管打折致远端开通失败、1例放置翻山鞘但出鞘管处动脉扭曲严重导管无法下行致开通失败、1例身材高大因球囊导管长度不够无法行远端扩张、2例远端无流出道无法行PTA术,PTA治疗技术成功率57.9%(11/19);两组比较P均小于0.01。研究组治疗后1W、1Mo及6Mo平均ABI均高于对照组,除治疗后1周两组比较无统计学差异外(P>0.05),治疗后1Mo及6Mo两组比较均有统计学差异(P<0.05).术后1W、1Mo及6Mo彩超检查血流速度结果研究组均优于对照组,两组比较差异有统计学意义。结论顺行股动脉穿刺PTA术治疗下肢动脉闭塞性病变明显优于逆行穿刺技术。Objective To observe the clinic effects of interventional treatment of lower extremity arterial Occlusive disease with antegrade femoral artery puncture. Methods The 33 cases of lower extremity arterial occlusive disease with a total of 41 limbs were enrolled, with 17 cases and 22 limbs in study group and 16 cases with 19 limbs in the control group. Antegrade femoral artery puncture technique in study group and contralateral retrograde femoral artery puncture technique in control group were used for interventional treatment of limb. The incidence of complications, technical success rate, postoperative lW, 1Me and 6Me the limb ankle - brachial index （ABI） and ultrasound examination and other related indicators were observed to evaluate blood flow velocity in two different groups. Results In study group the artery dissection occurred in 1 case, complication rate was 4.5% （ 1 / 22 ）. And in 1 patient the guide wire went into the subintimal and could not return to the true lumen. Two cases failed to meet the limb due to a longer duration of PTA successful treatment standards, technical success rate of 86.4% （ 19/22 ）. In control group sheath discount occurred in 2 cases, arterial dissection in 1 case, bleeding vascular guide wire perforation in 2 cases, catheter distortion in 2 eases, and complication rate was 36.8% （ 7 / 19 ）. PTA treatment success rate was 57.9% （ 11/19 ）. Average ABI in study group at 1W, 1Me and 6Me after treatment were higher than those in control group with significant difference except data at 1 week. After lW, 1Me and 6Mos ultrasonography showed that Blood Flow Velocity in the study group was better than that in the control group, the difference was statistically siguifieant. Conclusion PTA with antegrade femoral artery puncture in the treatment of lower extremity arterial occlusive disease is better than conventional retrograde puncture technique.

关 键 词：股动脉穿刺 介入治疗 动脉闭塞 

分 类 号：R543.5[医药卫生—心血管疾病]