下肢动脉硬化闭塞症患者腔内治疗的临床效果观察  

Special issues in endovascular treatment of lower extremities arteriosclerosis obliterans

作　　者：段红永[1] 管强[1] 梁宁[1] 杨笑非[1] 韩锋[1] 王振峰[1] 刘增庆[1] 

机构地区：[1]山西省人民医院血管外科,太原030012

出　　处：《中华医学杂志》2013年第13期1008-1011,共4页National Medical Journal of China

摘　　要：目的探讨下肢动脉硬化闭塞症腔内治疗的临床疗效。方法回顾性分析山西省人民医院血管外科从2010年7月至2012年7月行腔内治疗的下肢动脉硬化闭塞症患者34例（43条肢体），其中Fontaine分期为Ⅱb期16例，Ⅲ期10例，Ⅳ期8例；泛大西洋协作组织2007年标准分级A级4例，B级8例，C级9例，D级13例。全部患者行CT动脉成像或数字键影血管造影检查后给予腔内治疗，全部患者的病变动脉均行经皮穿刺腔内血管成形加支架植入术，其中9例患者（9条肢体）行股动脉内膜切除联合下肢腔内治疗。结果34例患者技术成功率为100％，1例髂动脉闭塞患者腔内治疗中出现髂动脉破裂，1例患者出现远端动脉穿孔，1例患者术后1周缺血无改善而截肢，1例患者术后3周支架内急性血栓形成，1例患者术后4周因肢体远端流出道不畅而致截肢，但截至平面降低。30例患者（38条肢体）平均随访13．3个月，术后6个月3条肢体出现闭塞；12个月4条肢体出现闭塞，24个月4条肢体出现闭塞。结论腔内治疗的近期效果良好。在腔内治疗过程中要注意特殊问题的处理，以防严重并发症并尽可能提高近、远期通畅率。Objective To explore the clinical efficacy of endovascular treatment for lower extremity arteriosclerosis obliterans. Methods A total of 34 patients （43 limbs） with lower extremity arteriosclerosis obliterans undergoing endovascular treatment from July 2010 to July 2012 were analyzed. The cohort had Fontaine stage Ⅱb （ n = 16 ）, Fontaine stage Ⅲ（ n = 10） and Fontaine stage Ⅲ （ n = 8 ）. Among them, the lesions were ofTASC ⅡA （n=4）,TASC ⅡB （n=8）, TASC ⅡC （n=9） andTASC ⅡD （n=13）. All patients underwent percutaneous transluminal angioplasty （PTA） plus stents after eomputed tomographic angiography （CTA） or digital subtraction angiography （DSA）. And 9 patients underwent femoral endarterectomy associated with endovascular treatment. Results The success rate of this technique was 100%. One iliac artery ruptured during endovascular surgery. One patient suffered intraoperatively from arterial perforation. One patient was amputated one week later. One patient had in-stent thrombosis at Week 3 post-treatment. One patient was amputated at Week 4 after endovascular treatment. Thirty patients （38 limbs） were followed up for 13.3 months. During the follow-up, 3,4 and 4 limbs became occluded at Month 6, 12 and 24 post-treatment respectively. Conclusion Endovascular treatment has an excellent early patency rate. Special issues should be properly handled during endovascular treatment.

关 键 词：动脉硬化 闭塞性 下肢 腔内治疗 

分 类 号：R654.3[医药卫生—外科学]