置管溶栓辅助腔内成形治疗下肢动脉闭塞的有效性和安全性  

Efficacy and Safety of Catheter-Directed Thrombolysis-Assisted Endovascular Angioplasty for the Treatment of Patients With Lower Limb Arterial Occlusion

作　　者：陈阳[1] 董徽[1] 蒋雄京[1] 车武强[1] 熊洪亮[1] 邹玉宝[1] 刘加林[1] CHEN Yang, DONG Hui, JIANG Xiong-jing, CHE Wu-qiang, XIONG Hong-liang, ZOU Yu-bao, LIU Jia-lin(Department of Cardiology, National Center for Cardiovascular Diseases and Fuwai Hospital, CAMS and PUMC, Beijing （100037）, China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室心内科,北京市100037

出　　处：《中国循环杂志》2018年第7期677-680,共4页Chinese Circulation Journal

基　　金：国家自然科学基金(81700440)

摘　　要：目的:评估置管溶栓辅助腔内成形治疗下肢动脉闭塞的有效性和安全性。方法:连续入选阜外医院2008-12至2017-04行置管溶栓辅助腔内成形治疗的下肢动脉闭塞患者共55例,均经造影证实病变部位有大量血栓影,置导管头端于血栓近端行尿激酶溶栓治疗,回顾性分析围术期临床资料、术后电话或门诊随访临床结果。结果:55例患者中男性49例,年龄(60.7±14.8)岁。慢性、亚急性和急性下肢缺血分别为38例、14例和3例。Fontaine分期Ⅱb期35例,Ⅲ期13例,Ⅳ期7例。55例患者中25例术中溶栓后再通,其余30例持续置管溶栓24~48 h。所有患者均行球囊扩张术,其中22例因残余狭窄>50%或夹层明显限制血流而置入支架。手术再通成功率为85.5%(47/55)。与术前比较,溶栓后下肢动脉平均闭塞长度明显缩短[(50.6±28.3)mm vs(145.4±43.6)mm,P<0.01],患侧踝臂指数(ABI)显著升高(0.67±0.41 vs 0.15±0.27,P<0.01)。围术期介入相关并发症3例。术后随访(39.0±24.3)个月,失访6例(10.9%),患肢血管通畅率65.3%(32/49),保肢率为93.9%(46/49),严重心血管不良事件5例(10.2%),其中心肌梗死3例,肺栓塞2例;死亡7例(14.3%)。结论:置管溶栓辅助腔内成形治疗合并急慢性血栓的下肢动脉闭塞安全、有效,并可显著减少病变部位支架的使用。Objectives： To evaluate the efficacy and safety of catheter-directed thrombolysis（CDT）-assisted endovascular angioplasty for the treatment of patients with lower extremity arterial occlusion.Methods： In this single-center retrospective study, the clinical data of 55 consecutive patients with lower extremity arterial occlusion underwent CDT-assisted endovascular angioplasty from December 2008 to April 2017 in our hospital were collected and analyzed. Telephone or clinic interviews were conducted to investigate the clinical outcomes.Results： The age of included patients ranged from 24 to 83（60.7±14.8） years,49（89.1%）patients were male. There were 38 chronic, 14 subacute and 3 acute lower limb ischemia, 35 patients were in Fontaine II b, 13 patients in Fontaine III and 7 patients in Fontaine IV stages. All patients received CDT therapy with urokinase after identifying the thrombus in lesion arteries by arteriography. Among them, occluded arteries were opened successfully in 25 patients immediately post therapy and the remaining 30 patients received continuous thrombolysis for 24-48 hours. All patients underwent balloon dilatation and stent implantation was performed in 22 patients because of residual stenosis 50% or restricted blood flow due to dissection. Procedural success rate was 85.5%（47/55）. The average occlusion length was significantly shorter after thrombolysis as compared to the baseline level（[50.6±28.3] mm vs [145.4±43.6] mm, P〈0.01）. The ankle and brachial index（ABI） was significantly higher post operation than at baseline（0.67±0.41 vs 0.15±0.27, P〈0.01）. Only 3 interventional complicationsoccurred during the perioperative period. During the（39±24.3） months follow-up, 6（10.9%） cases were lost to follow-up, cumulative patency rate was 65.3%（32/49） and limb salvage rate was 93.9%（46/49）, 5（10.2%） patients suffered from serious cardiovascular adverse events and 7（14.3%） patients died. Conclusions： CDT-assisted endovascular angioplasty is

关 键 词：下肢动脉闭塞 血栓 置管溶栓 腔内成形 

分 类 号：R541[医药卫生—心血管疾病]