机械血栓清除术治疗急性-亚急性股腘动脉支架内血栓21例  

Percutaneous Mechanical Thrombectomy for Recanalization of Acute and Subacute Thrombotic Femoropopliteal Artery Stent Occlusions

作　　者：张韬[1] 张学民[1] 张小明[1] 李伟[1] 李清乐[1] 焦洋[1] 蒋京军[1] 李伟浩[1] Zhang Tao;Zhang Xuemin;Zhang Xiaoming(of Vascular Surgery,Peking University People 's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院血管外科,北京100044

出　　处：《中国微创外科杂志》2019年第2期127-131,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨机械血栓清除术(percutaneous mechanical thrombectomy,PMT)治疗急性-亚急性股腘动脉支架内血栓的疗效。方法 2016年1月～2018年1月对21例因急性-亚急性股腘动脉支架内血栓行PMT(16例选择Rotarex机械血栓切除系统,5例选择AngioJet机械血栓切除系统),17例辅助动脉置管溶栓(catheter directed thrombolysis,CDT)和经皮血管腔内成形术(percutaneous transluminal angioplasty,PTA)、支架成形术。结果病变长度(15.5±4.9) cm。技术成功率Angiojet组100%(5/5);Rotarex组68.8%(11/16),5例联合CDT后成功率100%。辅助CDT 5例,残余病变行单纯PTA 12例,PTA辅助支架成形2例。临床成功率90.5%(19/21)。术后踝肱指数(ankle-brachial index,ABI)中位数0.72(0.40～1.20),明显高于术前中位数0.26(0.00～0.76)(Z=-3.640,P=0.001)。远端动脉栓塞发生率28.6%(6/21),穿刺点出血3例(14.3%),无穿孔、夹层、支架移位和肾功能衰竭并发症。21例随访(13.5±6.1)月,6个月一期通畅率81.1%(17/21),二期通畅率100.0%(21/21),无死亡,1例(4.8%)术后2个月患足因坏疽合并感染行足部截肢。结论机械血栓清除术适用于急性-亚急性股腘动脉支架内血栓。Objective To assess the effectiveness of percutaneous mechanical thrombectomy ( PMT) in the treatment of acute and subacute thrombotic occlusions in stent-grafts of femoropopliteal artery.Methods From January 2016 to January 2018,there were 21 patients with acute or subacute thromboses after stent-grafts of femoropopliteal artery.The patients were treated with PMT,16 of which were treated by using the Rotarex mechanical thrombectomy device and 5 of which were treated by using the AngioJet device.Among them,17 patients were given assisted catheter directed thrombolysis ( CDT),percutaneoius transluminal angioplasty ( PTA),or stent angioplasty.Results The average lesion length was ( 15.5 ± 4.9) cm.The immediate technical success rate was 100%( 5 /5) in the AngioJet group and 68.8%( 11 /16) in the Rotarex group.A total of 5 cases with combined CDT obtained a technical success rate of 100%.The residual lesions were treated with PTA in 12 cases and PTA assisted stent angioplasty in 2 cases.The overall clinical success rate was 90.5%( 19 /21).The median postoperative ankle-branchial index was 0.72 ( range,0.40 - 1.20),which was significantly higher than preoperation [0.26 ( 0.00 - 0.76),Z =- 3.640,P = 0.001].The complication rate of distal embolization was 28.6%( 6 /21 ) and puncture hemorrhage happened in 3 cases ( 14.3%).There were no complications of perforation,dissection,stent displacement or renal failure.The follow-ups for ( 13.5 ± 6.1) months in 21 cases showed the primary patency rate of 81.1%( 17 /21) and the secondary patency rate of 100.0%( 21 /21) after 6 months.No fatal case was seen.One case ( 4.8%) suffered from foot gangrene and infection and underwent foot amputation 2 months after operation.Conclusion PMT is a choice for acute and subacute thrombosis of thrombotic femoropopliteal artery stent occlusions.

关 键 词：机械血栓清除术 血栓 支架 股动脉 腘动脉 

分 类 号：R654.4[医药卫生—外科学]