腔内治疗TASC Ⅱ D型髂动脉硬化闭塞症并发症12例分析  

Analysis of 12 Cases of Complications of Endovascular Treatment for TASCⅡD Iliac Arteriosclerosis Obliterans

作　　者：秦少华[1] 王小微 赵堂海[1] 郝庭嘉 战激光[1] Qin Shaohua;Wang Xiaowei;Zhao Tanghai(Department of Vascular Surgery,No.970 Hospital of PLA,Yantai 264002,China;不详)

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 [2]中国人民解放军第九六七医院血管外科,大连116000

出　　处：《中国微创外科杂志》2021年第6期519-523,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腔内技术治疗泛大西洋协作组织(TransAtlantic Inter-Society Consensus,TASC)诊治指南ⅡD型髂动脉硬化闭塞症并发症的原因及防治策略。方法2014年6月~2019年12月,我院采用腔内技术治疗TASCⅡD型髂动脉硬化闭塞症57例,发生围手术期并发症12例,对其资料进行回顾性分析。结果腔内操作相关并发症5例,包括术中髂动脉破裂1例,植入覆膜支架后动脉破口封堵不彻底,开放手术治愈;术后2 h迟发性髂动脉破裂1例,植入覆膜支架治愈;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,经球囊扩张+裸支架植入治愈;术后患肢蓝趾征2例,保守治疗治愈。穿刺点并发症2例,均行开放手术治愈。造影剂肾病(contrast-induced nephrology,CIN)5例,均经保守治疗肌酐恢复正常。12例均经门诊随访(22.7±11.6)月,2例术后14、20个月CTA检查示支架内再闭塞,10例病情稳定,无复发。结论并发症的原因主要是闭塞病变范围广、管壁钙化严重、基础疾病及术者技术水平。为减少并发症发生,应术前充分评估病变特点,选择合理的手术入路和方案,备齐各类器材及开放手术准备,对并发症早发现、早处理。Objective To investigate the causes and prevention strategy of complications caused by endovascular technique in the treatment of TransAtlantic Inter-Society Consensus(TASC)ⅡD iliac arteriosclerosis obliterans.Methods From June 2014 to December 2019,57 patients with TASCⅡD iliac arteriosclerosis obliterans accepted endovascular treatment,and 12 of them occurred complications during the perioperative period.The clinical data of these cases were retrospectively analyzed.Results Five cases had complications related to endovascular operation,including 1 case suffered iliac artery rupture after stent implantation during operation(the covered stent was implanted 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(was cured by implantation covered stent),1 case of the contralateral common iliac artery embolization caused by plaque displacement during the retrograde opening of the occluded left iliac artery(was cured by balloon dilation+stent implantation),and 2 cases of blue-toe sign in the affected limb(both got better after the conservative treatment).Two cases had complications at the puncture point,and both of them were cured by open operation.Five cases had contrast-induced nephrology(CIN)after operation,all of them recovered to normal creatinine level after conservative treatment.All the 12 cases were followed up for an average of(22.7±11.6)months.Intra-stent restenosis was found in 2 cases by computed tomographic angiography,which occurred 14 and 20 months after surgery,respectively.The remaining 10 cases were stable without recurrence.Conclusions The main reasons for the complications involve wider occlusion lesions,severe calcification of arterial wall,basic diseases and the skill of the operator.The following aspects are important to prevent complications:evaluating the characteristics of vascular lesions sufficiently before the operation;selecting reasonable surgical access and plan;arr

关 键 词：髂动脉 动脉闭塞性疾病 血管腔内治疗 并发症 

分 类 号：R73[医药卫生—肿瘤]