拄拐导致腋动脉闭塞的介入治疗  

Interventional therapy of crutch-induced axillary artery occlusion

作　　者：宋进华[1] 顾建平[1] 楼文胜[1] 何旭[1] 陈亮[1] 陈国平[1] 苏浩波[1] 汪涛[1] 徐克[2] 

机构地区：[1]南京医科大学附属南京医院介入科,210006 [2]中国医科大学附属第一医院放射科

出　　处：《中华放射学杂志》2013年第4期357-360,共4页Chinese Journal of Radiology

基　　金：国家科技部“十一五”科技支撑计划资助项目（2007BA105804）

摘　　要：目的探讨拄拐导致腋动脉闭塞的介入治疗方法和效果。方法6例长期拄拐患者突发腋动脉闭塞并伴有血栓形成，CTA和DSA检查明确诊断。采用泥鳅导丝行血栓闭塞段导丝穿通术，置入溶栓导管团注尿激酶25万u，然后保留导管尿激酶持续泵入1—3d。置管溶栓治疗后24、48、72h行造影复查。造影显示血栓完全溶解并且显露动脉狭窄时，行狭窄段球囊扩张术，其中2例行支架置入术。结果6例患者经置管溶栓治疗及血管腔内治疗后腋动脉均恢复通畅。1例球囊扩张患者3个月后腋动脉再次闭塞，予支架置入后血流恢复通畅，其余患者随访期间上肢动脉血流保持通畅。所有病例均未见明显并发症。结论长期使用腋拐是腋动脉闭塞的原因之一，血管腔内治疗拄拐导致的腋动脉闭塞伴急性血栓形成具有疗效肯定、微创、安全的特点。Objective To evaluate the endovascular therapy in the treatment of crutch-induced axillary artery occlusion and to discuss its technical points. Methods Acute axillary artery occlusion accompanied with thrombosis following long-time usage of unilateral axillary crutch were verified in 6 cases by computed tomography angiography （CTA） and digital subtraction angiography（DSA）. Fist the guide-wire was inserted and pushed forward to pass through the thrombus, then bolus injection of urokinase （250 000 Units）through catheter was performed, Transcatheter micro-pump continuous infusion of urokinase was employed for 1--3 days until the thrombosis was completely dissolved, which was confirmed by angiography re-examination after 24,48 and 72 hours. Then the PTA and stents were implanted in those patients who revealed artery stenosis. Results The axillary arteries in 6 cases were proved to he reopen by post- treatment angiography. Occlusion of the axillary artery in a patient 3 month after the procedure was observed and was successfully treated with a stent. The other upper extremity arteries kept patency during follow-up. No major complications occurred and no patients died of complications related to the procedures. Conclusion Chronic axillary crutch use may he associated with axillary artery occlusion. For the treatment of acute crutch-induced axillary artery occlusion, endovascular treatment is a minimally invasive, effective, safe technique.

关 键 词：腋动脉 闭塞 血栓形成 放射学 介入性 

分 类 号：R543[医药卫生—心血管疾病]