逆向导丝技术在下肢动脉慢性闭塞病变腔内治疗应用分析  

Application of retrograde wire technique in intervention in arteriosclerosis obliterans

作　　者：吴璐思[1] 董豪坚[2] 林锦信 叶景光[2] 罗德谋[2] 沈宁[3] 黄文晖[2] 刘媛[2] 罗建方 

机构地区：[1]广东省人民医院(广东省医学科学院)检验科,广州510100 [2]广东省心血管病研究所心内科广东省人民医院(广东省医学科学院),广州510080 [3]广东省揭阳市人民医院心内科,广东揭阳522000

出　　处：《岭南心血管病杂志》2016年第3期258-261,277,共4页South China Journal of Cardiovascular Diseases

基　　金：2013年广东省省级科技计划项目(项目编号:2013B031800024)

摘　　要：目的探讨逆向导丝技术治疗下肢动脉慢性闭塞(chronic total occlusion,CTO)病变介入治疗的技术要点、成功率及临床疗效。方法回顾性收集广东省人民医院2011年5月至2014年5月使用逆向导丝技术进行下肢动脉CTO病变经皮经腔血管成形术(percutaneous transluminal angioplasty,PTA)治疗的患者资料,分析逆向导丝各种方法特点、手术成功率,比较术前、术后Rutherford分级以及12个月保肢率。结果共筛查62例下肢动脉介入治疗患者,其中CTO病变45例,使用逆向导丝技术21例(经侧支循环路径13例,逆穿远端重建区血管8例),成功开通CTO病变16例,患者术后踝肱指数(ABI)平均值提高(P<0.05),Rutherford分级及跛行距离改善,1年的小范围肢体截肢率为9.52%,大范围肢体截肢率为10%。术中无主要并发症发生,无1例发生住院期间死亡。结论逆向导丝技术是下肢动脉CTO病变介入治疗的重要手术方式,能进一步提高手术成功率,有效改善下肢缺血程度。Objectives To evaluate the effect, success rate and technical key points of retrograde wire technique in intervention in arteriosclerosis obliterans （ASO） for chronic total occlusion （CTO）. Methods The data of patients in Guangdong General Hosptial with ASO was retrospectively collected and analyzed from May 2011 to May 2014, for whom retrograde wire technique was performed in percutaneous transluminal angioplasty （PTA） procedure. The technical characteristics, procedure success rate and amputation rate in 12 months＇ follow-up were evaluated. Rutherford categories and ankle-brachial index （ABI） were compared before and after procedure. Results A total of 62 patients were screened, among who, there were 45 cases with CTO. A number of 21 cases of CTO patients with retrograde wire technique were enrolled, including 13 cases with side branch approach and 8 cases with retrograde puncture technique. Sixteen cases were successfully revascularized, of whom, average ABI, claudication distance and Rutherford categories of cohom, significantly improved （P〈0.05）. The minor amputation rate was 9.52% and major amputation was 0 in 12 months＇ follow-up. No major complications occurred during procedure and no death during hospitalization. Conclusions Retrograde wire technique is an important and effective method for intervention in ASO for CTO, which can further improve procedure success rate and limb ischemia.

关 键 词：下肢动脉闭塞症 经皮 经腔血管成形术 逆向技术 

分 类 号：R543.5[医药卫生—心血管疾病]