导管接触溶栓在下肢动脉硬化闭塞慢性缺血治疗中的应用  

Application of catheter-directed thrombolysis in the treatment of lower extremity arteriosclerosis obliterans with chronic ischemia

作　　者：刘洪[1] 王学虎[1] 李凤贺[1] 赵渝[1] LIU Hong;WANG Xuehu;LI Fenghe;ZHAO Yu(Department of Vascular Surgery,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院血管外科

出　　处：《介入放射学杂志》2019年第11期1032-1035,共4页Journal of Interventional Radiology

摘　　要：目的评价导管接触溶栓(CDT)治疗下肢动脉硬化闭塞症(ASO)慢性缺血的有效性和安全性。方法回顾性分析2015年1月至2018年11月采用CDT辅助血管成形术治疗189例下肢ASO慢性缺血患者临床资料,评价溶栓有效率、并发症等。结果 189例患者均成功实施CDT治疗,溶栓有效率为88.4%(167/189)。动脉闭塞病变平均长度由术前(173±24) mm缩短为术后(81±16) mm(P<0.01)。153例患者病变血管泛大西洋学会联盟(TASC)Ⅱ分型较术前改善。CDT后进一步完成血管成形术,踝-肱指数(ABI)由术前0.31±0.12显著升高至术后0.82±0.21(P<0.01)。CDT期间总并发症发生率为28.6%(54/189),无颅内出血等严重并发症发生。结论下肢ASO慢性缺血患者CDT辅助治疗可提高血管成形术效率,具有较高的有效性和安全性。Objective To evaluate the efficacy and safety of catheter-directed thrombolysis(CDT) in treating lower extremity arteriosclerosis obliterans(ASO) with chronic ischemia. Methods The clinical data of189 patients with chronic ASO ischemia of lower extremities, who were treated with CDT-assisted angioplasty during the period from January 2015 to November 2018, were retrospectively analyzed. The effective rate of thrombolysis and complications were evaluated. Results Successful CDT was accomplished in all 189 patients, the effective rate of thrombolysis was 88.4%(167/189). The mean length of arterial occlusion decreased from preoperative(173±24) mm to postoperative(81±16) mm(P<0.01). In 153 patients, the TransAtlantic Inter-Society Consensus(TASC) Ⅱ classification of their diseased vessels was improved when compared with the preoperative classification. Subsequent endovascular angioplasty was performed after CDT. The anklebrachial index(ABI) was significantly increased from preoperative 0.31±0.12 to postoperative 0.82±0.21, the difference was statistically significant(P <0.01). The total incidence of complications wa s 28.6%(54/189)during the whole course of CDT therapy, and no severe complications such as intracranial hemorrhage occurred. Conclusion For lower extremity arteriosclerosis obliterans with chronic ischemia, CDT adjuvant therapy can improve the success rate of angioplasty. This technique has higher effectiveness and safety.

关 键 词：导管接触溶栓 下肢动脉硬化闭塞症 慢性缺血 血管内成形术 

分 类 号：R654.4[医药卫生—外科学]