股腘动脉双通路介入治疗股浅动脉慢性完全闭塞  

Dual access intervention via femoropopliteal artery for the treatment of chronic total occlusion of superficial femoral artery

作　　者：姚晔[1] 张文龙[1] 李琼[1] 王嵩[1] 

机构地区：[1]上海中医药大学附属龙华医院放射科,200032

出　　处：《介入放射学杂志》2016年第11期1002-1006,共5页Journal of Interventional Radiology

基　　金：上海市卫生局科教处课题项目(20134169)

摘　　要：目的评估仰卧位顺行再通失败后,股腘动脉双通路技术在股浅动脉慢性完全闭塞(CTO)中应用的安全性和临床意义。方法收集2012年5月至2014年5月收治的顺行开通失败后改经腘动脉逆向穿刺并配合顺行开通术的股浅动脉CTO患者36例,术前均表现为间歇性跛行,其中11例有静息痛,5例足趾缺血性溃疡;股浅动脉平均闭塞长度为(88.4±5.6)mm,平均踝-肱指数(ABI)为0.52±0.12。手术均先采用经对侧股动脉穿刺顺行开通,失败后取仰卧位结合透视或路径图导引下经腘动脉逆行穿刺,导丝逆行通过闭塞段进入真腔后再作闭塞段球囊扩张及支架植入术。比较术前及术后1 d、1个月、6个月、12个月患者症状及血管通畅率。结果 36例患者均通过股腘动脉双入路开通闭塞段动脉,共植入支架68枚,技术成功率100%。所有患者无穿刺点出血、血肿、假性动脉瘤、夹层、动静脉瘘、神经损伤等并发症,间歇性跛行症状均得到改善。术后1个月超声随访未出现支架内再狭窄,术后6个月有6例出现支架内再狭窄,但无明显症状;术后12个月27例中有13例支架内再狭窄,其中3例再次出现间歇性跛行,复查造影后予以球囊扩张,症状得到缓解。11例术前静息痛患者术后缓解,术后1、6个月随访中未再出现静息痛。5例足部溃疡患者中2例术后1个月内愈合,3例术后3个月内完全愈合。ABI由术前0.52±0.12改善至术后1 d 0.83±0.16(n=36,P<0.05),术后1个月0.82±0.12(n=36,P<0.05),术后6个月0.75±0.10(n=36,P<0.05),术后12个月0.68±0.13(n=27,P<0.05)。结论股浅动脉CTO患者仰卧体位下经股动脉顺行和腘动脉逆行开通闭塞段技术安全、有效,患者耐受性好,近期疗效确切,是股浅动脉CTO治疗的有效选择。Objective To evaluate the safety and clinical significance of dual access intervention via femoropopliteal artery in treating chronic total occlusion （CTO） of superficial femoral artery （SFA） when antegrade recanalization procedure in supine position failed. Methods A total of 36 patients with CTO of SFA, who were admitted to authors＇ hospital during the period from May 2012 to May 2014 to receive retrograde puncture of popliteal artery combined with dual access intervention via femoropopliteal artery because antegrade recanalization procedure failed, were enrolled in this study. Before operation, all patients complained of intermittent claudication. Among the 36 patients, 11 had rest pain and 5 had ischemic ulceration on toes. The average occlusion length of SFA measured on preoperative MRA was （88.39±5.6） mm, and the mean preoperative ankle-brachial index （ABI） was 0.52±0.12. Puncture of contralateral femoral artery to perform antegrade recanalization was adopted first; when it failed, the retrograde puncture of popliteal artery guided by fluoroscopy or road mapping was carried out in supine position, the guide wire was retrogradely inserted and was pushed through the obstructed segment until its tip entered the arterial true lumen, which was followed by balloon dilation and stent implantation for the obstructed segment. The improvement of symptoms and the vascular patency rate were determined before the operation as well as one day, one, 6 and 12 months after the operation, the results were analyzed and compared. Results The obstructed segment was recanalized with dual access intervention technique in all 36 patients; a total of 68 stents were implanted, and the technical success rate was 100%. No complications, such as puncture point bleeding, hematoma, pseudoaneurysm, dissection, arteriovenous fistula or nerve injury, occurred. The symptoms of intermittent claudication were improved in all patients. Follow-up ultrasound examination performed at one month after the operation showed that no

关 键 词：动脉闭塞性疾病 股动脉 腘动脉 经皮腔内血管成形术 

分 类 号：R654.4[医药卫生—外科学]