TASCⅡ D型髂动脉硬化闭塞症的腔内治疗  

Endovascular treatment for TASCⅡD iliac arteriosclerosis obliterans

作　　者：秦少华[1] 郝庭嘉 战激光[1] 赵堂海[1] Qin Shaohua;Hao Tingjia;Zhan Jiguang;Zhao Tanghai(Department of Vascular Surgery,The 970th Hospital of PLA,Yantai 264002,China)

机构地区：[1]中国人民解放军第九七〇医院血管外科,烟台264002

出　　处：《中华血管外科杂志》2020年第4期249-254,共6页Chinese Journal of Vascular Surgery

摘　　要：目的探讨腔内技术治疗TASCⅡD型髂动脉硬化闭塞症的有效性和安全性。方法回顾性分析2014年6月至2018年12月中国人民解放军第九七〇医院应用腔内技术治疗46例(65条肢体)TASCⅡD型髂动脉硬化闭塞症患者的临床资料。观察手术疗效和随访情况。结果手术成功率为95.7%(44/46),其中球囊扩张(PTA)+支架植入37例,导管接触溶栓(CDT)+PTA+支架植入7例。44例腔内开通的患者中,Rutherford分级较术前提高3级10例,提高2级23例,提高1级8例,分级无改善3例。术后1周患肢ABI较术前明显提高[0.86±0.10比0.34±0.21,t=-15.008,P<0.001]。11例(23.9%)患者出现腔内治疗相关并发症,其中术中髂动脉破裂1例,植入覆膜支架后动脉破口封堵不彻底,予以开放手术治愈;术后2 h迟发性髂动脉破裂1例,经植入覆膜支架痊愈;逆行开通闭塞的髂动脉过程中斑块脱落导致对侧髂总动脉栓塞1例,经PTA+裸支架植入术治愈;术后患肢出现蓝趾征2例,血肌酐水平升高5例,均经保守治疗好转;左侧肱动脉血栓形成1例,行开放手术治愈。44例腔内开通的患者均获得随访,随访(33.1±13.7)个月,术后1、2和3年一期通畅率分别为95.5%、87.1%和72.2%,二期通畅率分别为97.7%、93.5%和88.9%。随访期间2例患者死亡,1例行膝下截肢术。结论腔内技术治疗TASCⅡD型髂动脉硬化闭塞症切实可行,是一种安全、有效、微创的方法。Objective To investigate the feasibility and safety of the endovascular technique in the treatment of TASCⅡD iliac arteriosclerosis obliterans.Methods The clinical data of 46 patients(65 limbs)with TASCⅡD iliac arteriosclerosis obliterans accepted endovascular treatment from June 2014 to December 2018 were retrospectively analyzed.The surgical outcomes and follow-up were observed.Results The success rate of the operation was 95.7%(44/46),including 37 cases with percutaneous transluminal angioplasty(PTA)+stent implantation,and 7 cases with catheter-directed thrombolysis(CDT)+PTA+stent implantation.The clinical effects of 44 cases underwent endovascular treatment were satisfactory.At the first week after surgery,10 cases had three-grade improvement of the Rutherford classification,23 cases had two-grade improvement,8 patients had one-grade improvement,and 3 patients had no improvement.The post-operation ankle-brachial index(ABI)was significantly higher than pre-operation(0.86±0.10 vs 0.34±0.21,t=-15.008,P<0.001).Eleven cases(23.9%)had complications related to endovascular therapy,including 1 patient who suffered from iliac artery rupture after PTA during operation,and underwent covered stent implantation immediately,but the rupture was not completely blocked,at last this patient was cured by open surgery;1 case suffered delayed iliac artery rupture 2 hours after operation,and was cured by implantation of a covered stent;1 case developed the contralateral common iliac artery embolization caused by plaque displacement during the retrograde opening of the occluded left iliac artery,and was cured by PTA and stent implantation;there were 2 cases with blue toe sign and 5 cases with elevated serum creatinine level,and got better by conservative treatment;1 case suffering from left brachial artery thrombosis was cured by open operation.Furthermore,44 patients receiving endovascular treatment were followed up for(33.1±13.7)months,the 1,2,3-year primary patency rate was 95.5%,87.1%and 72.2%,and secondary patency rate

关 键 词：髂动脉 动脉闭塞性疾病 腔内治疗 并发症 

分 类 号：R654.3[医药卫生—外科学]