下肢动脉硬化闭塞症腔内治疗后支架内再狭窄的治疗  

Management of in-stent restenosis in lower limb arteriosclerosis obliterans after endovascular treatment

作　　者：吴元兵[1] 朱云峰[1] 葛红卫[1] 朱永斌[1] 陈诚[1] 王鑫[1] 

机构地区：[1]苏州大学附属第三医院血管外科,江苏常州213003

出　　处：《中国普通外科杂志》2015年第12期1687-1690,共4页China Journal of General Surgery

摘　　要：目的：探讨下肢动脉硬化闭塞症（ASO）腔内治疗后支架内再狭窄的治疗体会。方法：回顾性分析2012年6月至2014年12月收治的支架内再狭窄的31例下肢ASO患者（49条肢体）资料,其中狭窄病变37条肢体,闭塞病变12条肢体;病变长度8.5-35 cm,平均（25.2±7.5）cm。结果：所有患者均接受腔内治疗,包括单纯球囊扩张成形术35例,球囊扩张后导管溶栓术3例,球囊扩张后支架植入术3例,导管溶栓后球囊扩张术7例,斑块旋切术1例。术后所有患者症状均不同程度缓解,平均踝肱指数较术前明显升高（P〈0.05）。28例获得随访3-32个月,平均（16.2±5.8）个月,期间出现再狭窄6例（21.4%）,均再次行球囊扩张成形术,无截肢及死亡病例。结论：结合其他腔内疗法,球囊扩张术治疗下肢动脉支架内再狭窄疗效满意。Objective： To review the experience in management of in-stent restenosis in lower limb arteriosclerosis obliterans （ASO） after endovascular treatment. Methods： The clinical data of 31 lower limb ASO patients （49 limbs） with post-interventional in-stent restenosis treated from June 2012 to December 2014 were analyzed retrospectively. The lesions included restricture in 37 limbs and with reocclusion in 12 limbs, and the length of lesions ranged from 8.5 to 35 cm with an average of 25.2 cm. Results： All patients received endovascular treatment. The treatment modalities included lone balloon dilation angioplasty in 35 limbs, catheter-directed thrombolysis after balloon dilation in 3 limbs, balloon dilation with additional stent implantation in 3 limbs, catheter-directed thrombolysis prior to balloon dilation in 7 limbs, and SilverHawk atherectomy in one limb. After operation, varying degrees of improvement of symptoms occurred in all cases, and the average ankle-brachial index was increased significantly compared with preoperative value （P〈0.05）. Twenty-eight patients were followed up for 3 to 32 months with an average of 16.2 months, during which period, restenosis recurred in 6 cases （21.4%）, and all of them had a repeat balloon dilation angioplasty, and no case had limb amputation or died. Conclusion： In combination with other appropriate endovascular procedures, balloon dilation angioplasty can offer satisfactory efficacy for in-stent restenosis in lower limb arteries.

关 键 词：动脉闭塞性疾病 移植物闭塞 血管 腔内治疗 

分 类 号：R654.3[医药卫生—外科学]