SilverHawk斑块切除成形对比球囊扩张成形治疗严重膝下动脉硬化闭塞性病变  

SilverHawk Plaque Excision Versus Angioplasty for Symptomatic Infrapopliteal Arterial Occlusive Disease

作　　者：郭建明[1,2] 谷涌泉[1,2] 郭连瑞[1,2] 佟铸[1,2] 崔世军[1,2] 高喜翔[1,2] 马天宇[1,2] 李杨[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：《中国普外基础与临床杂志》2015年第8期922-925,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨Silver Hawk斑块切除成形治疗严重膝下动脉硬化闭塞性病变的安全性和有效性。方法回顾性分析我院2011年6月至2013年10月期间治疗的54例严重膝下动脉硬化闭塞性疾病患者的临床及随访资料,其中男29例,女25例,年龄(65.8±4.5)岁,病程(25.1±3.3)个月,均为Fontaine分级Ⅱb级及以上。根据治疗方法分为斑块切除组(9例)和球囊扩张组(45例),观察2组的技术成功率、围手术期并发症和术后出院前至术后6、12个月时的踝肱指数(ABI)、保肢率和未再次手术干预率指标。结果 1 2组患者的性别、年龄、合并疾病、ABI、流出道评分、病变长度等一般临床资料比较差异均无统计学意义(P>0.05)。2斑块切除组和球囊扩张组的技术成功率比较差异无统计学意义〔100%(9/9)比86.7%(39/45),P=0.574〕,球囊扩张组失败的6例中4例因为导丝不能通过病变段,2例因为严重残余狭窄。3斑块切除组和球囊扩张组血管相关并发症发生率比较差异无统计学意义〔11.1%(1/9)比11.1%(5/45),P=1.000〕。4随访结果:斑块切除组有1例患者术后4个月因颈动脉重度狭窄而接受颈动脉内膜剥脱,下肢无新发症状。球囊扩张组有1例患者术后3个月因心肌梗死去世,有2例患者因肺部感染、心功能衰竭分别于术后4个月和5个月去世。2组术后6个月和12个月时的保肢率和未再次手术干预率比较,差异均无统计学意义(P>0.05),2组术后12个月时的ABI和ABI平均改善值比较差异也均无统计学意义(P>0.05)。结论 Silver Hawk斑块切除成形在治疗严重膝下动脉硬化闭塞病变方面是一种安全、有效的方法,其治疗效果不劣于球囊扩张成形。Objective To evaluate the safety and efficiency of Silver Hawk plaque excision in treatment of symptomatic infrapopliteal arterial occlusive disease（IPAD）. Methods The clinical and follow-up data of 54 consecutive patients with IPAD underwent endovascular treatment from 2011 to 2013 in this hospital were analyzed retrospectively. There were29 males and 25 females. The age was（65.8±4.5） years, the period was（25.1±3.3） months. All the patients were Fontaine grade Ⅱb-Ⅳ. The patients were divided into plaque excision group（n=9） and angioplasty group（n=45） according to the treatment method. The rates of technical success, perioperative complications, limb salvage and reintervention were observed between two groups. Results 1 There were no significant differences in the gender, age, complications, ankle brachial index（ABI）, outflow tract score, lesion length, and other clinical data between the 2 groups（P〉0.05）. 2 The technical success rate had no significant difference between the plaque excision group and the angioplasty group 〔100%（9/9） versus 86.7%（39/45）, P=0.574〕. Six cases were failed because the guide wire could not pass through the diseased segment in4 cases and there were 2 cases of serious residual stenosis in the angioplasty group. 3 There was no significant difference in the incidence of vascular complications between the 2 groups 〔11.1%（1/9） versus 11.1%（5/45）, P=1.000〕. 4 The follow-up results： One case was received the carotid endarterectomy on 4 months after operation because of severe carotid artery stenosis, the lower limbs had no new onset of symptoms in the plaque excision group. One patient due to myocardial infarction was death on 3 months after operation, 2 patients due to pulmonary infection and heart failure were death on 4 months and 5 months after operation respectively in the angioplasty group. The limb salvage rates and reintervention rates on 6 months and 12 months after operation had no significant differences between the 2 gr

关 键 词：斑块切除 球囊扩张 动脉硬化闭塞症 膝下 

分 类 号：R654.4[医药卫生—外科学]