Silverhawk斑块切除成形治疗严重膝下动脉硬化闭塞性病变  

Silverhawk atherectomy and adjunctive angioplasty for severe arterial atherosclerotic occlusive disease below the knee

作　　者：郭建明[1,2] 谷涌泉[1,2] 郭连瑞[1,2] 佟铸[1,2] 武欣[1,2] 崔世军[1,2] 高喜翔[1,2] 张建[1,2] 汪忠镐[1,2] 

机构地区：[1]首都医科大学宣武医院血管外科 [2]首都医科大学血管外科学系,北京100053

出　　处：《中国普通外科杂志》2014年第6期732-736,共5页China Journal of General Surgery

基　　金：北京市科委资助项目(Z121100005512009);首都特色学科资助项目(Z131107002213041)

摘　　要：目的:探讨Silverhawk斑块切除成型治疗严重膝下动脉硬化闭塞性病变的安全性和有效性。方法:回顾分析2年来治疗的9例该病患者临床与随访资料。其中男性3例,女性6例,平均年龄(64.0±9.1)岁,病程(28.9±25.9)个月;下肢间歇性跛行5例,静息痛1例,足趾溃疡1例,坏疽2例;6例病变位于胫腓干动脉,1例位于胫前动脉,2例位于胫后动脉;1例行单纯斑块切除,余8例患者均同时采用介入技术处理了流入道动脉病变。结果:所有手术均获得成功。出院时所有患者再通血管保持通畅。跛行患者跛行距离均增至500 m以上,1例静息痛术后缓解,1例足趾溃疡面积缩小,2例坏疽呈干性无感染。患者术后踝肱比值(ABI)均较术前增加。所有患者得到随访,平均时间为(24.0±9.5)个月。1例患者术后23个月因心肌梗死死亡;1例患者间歇性跛行距离较术后最好时期有所减少,但仍优于术前;静息痛患者疼痛症状消失;溃疡患者伤口愈合;2例坏疽患者,1例仍保持干性状态,另1例其坏疽两趾脱落,创面愈合。结论:Silverhawk斑块切除成型治疗严重膝下动脉硬化闭塞病变是一种安全有效的方法,是否能够成为一种常规的技术,还需要随机对照研究远期结果的验证。Objective： To investigate the safety and efficacy of Silverhawk atherectomy and adjunctive angioplasty in treatment of severe arterial atherosclerotic occlusive lesion below the knee.Methods： The clinical and follow-up data of 9 patients with this condition treated over the past 2 years were retrospectively analyzed. Of the patients, 3 cases were male and 6 were female, with a mean age of （64.0±9.1） years and mean disease course of （28.9±25.9） months; 5 cases had intermittent claudication, one case had rest pain, one case had toe ulcer, and 2 cases had toe gangrene; the occlusive lesion in 6 cases was located in the tibioperoneal trunk, in one case in the anterior tibial artery, and in 2 cases in the posterior tibial artery; one case underwent plaqueexcision alone and the other 8 cases underwent simultaneous endovascular procedure for the inflow arterial lesion. Results： All operations were successfully performed, and the recanalized artery was patent in all patients atdischarge. The claudication distance increased to more than 500 m in the 5 claudication patients and the case with rest pain was relieved; the wound size of the one case with toe ulcer was reduced, and the gangrene in the 2 patients became dry and was not infected. Postoperative ankle brachial index （ABI） was increased in all patients compared with their preoperative value. All patients were followed-up for an average of （24.0±9.5） months.One patient died 23 months after operation due to myocardial infarction; claudication distance in one patient was decreased compared with the former best postoperative distance, but was still longer than the preoperativedistance; the wound was healed in the ulcer patient; the rest pain that was present in one patient was relieved; of the 2 patients with toe gangrene, the dry state was kept in one case and in another case, the two gangrenous toesspontaneously detached and the wounds were healed. Conclusion： Silverhawk atherectomy and adjunctive angioplasty is a safe and effective method i

关 键 词：动脉闭塞性疾病 外科学 下肢 斑块切除术 

分 类 号：R445.1[医药卫生—影像医学与核医学]