内膜下血管成形术治疗下肢动脉硬化闭塞症  

Subintimal angioplasty treatment for arteriosclerosis obliterans of lower extremity

作　　者：姜福亭[1] 王中华[2] 潘培涛[1] 陈学东[1] 田磊[1] 杨晓冬[1] 王世华[1] 王育红[1] 

机构地区：[1]海军总医院,北京100048 [2]海军总医院普通外科,100048

出　　处：《中国临床医学影像杂志》2012年第6期407-409,413,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨内膜下血管成形术(SIA)治疗下肢动脉硬化闭塞症的技术方法和临床效果。方法:2007年6月—2010年6月,下肢动脉硬化闭塞症患者55例(60条肢体)在我院进行腔内治疗,通过SIA方法对闭塞段动脉进行再通后,采用经皮腔内血管成形术联合支架植入。总结分析SIA治疗技术、临床效果、并发症及随访情况。结果:55条肢体获得技术成功,SIA技术成功率91.7%(55/60),术后肢体缺血症状完全消失或明显改善,患肢踝肱指数(ABI)由术前的0.40±0.11增至术后7 d的0.82±0.13(P<0.000 1,t=18.29)。围手术期并发症发生率为8.33%,包括穿刺点血肿3例,动脉穿孔2例,无严重并发症出现及死亡病例。术后12月、24月分别随访38条肢体和23条肢体,随访中4例发生再狭窄并有明显缺血症状,经PTA解除,一期通畅率分别为81.6%(31/38)和73.9%(17/23),二期通畅率分别为89.5%(34/38)和78.3%(18/23),术后24月肢体保全率为100%(23/23)。结论:在下肢动脉闭塞性病变的腔内治疗中,SIA安全、有效,近期通畅率和肢体保全率较高。Objective： To explore the method and effectiveness of subintimal angioplasty（SIA） treatment for arteriosclerosis obliterans disease of lower extremity.Methods： Between Jun 2007 and Jun 2010,55 patients（60 limbs） with arteriosclerosis obliterans disease of lower extremity in our hospital were treated by interventional therapy.SIA was used for recanalization of the occlusive arteries.SIA treatment techniques,clinical effect,perioperative complications and follow-up results were analyzed.Results： The technical success rate of SIA was 91.7%（55/60）,with the clinical symptoms disappeared or improved significantly.Ankle-brachial index（ABI） increased from 0.40±0.11 to 0.82±0.13 with significant difference（P〈0.000 1,t=18.29）.The perioperative rate was 0%.Five patients（8.33%） had perioperative complications,with 3 cases of hematoma and 2 cases of artery perforation.Four cases of restenosis were treated by PTA during midterm follow-up.The primary patency rates were 81.6%（31/38） and 73.9%（17/23）,and the secondary patency rates were 89.5%（34/38） and 78.3%（18/23） at 12 and 24 months,respectively.The limb salvage rate was 100%（23/23） at 24 months.Conclusion： SIA in total occlusive disease of lower extremity is safe and effective.The patency and limb salvage rates can be achieved.

关 键 词：动脉硬化 闭塞性 下肢 血管成形术 放射学 介入性 

分 类 号：R543.5[医药卫生—心血管疾病] R815[医药卫生—内科学]