俯卧位超声引导腘动脉穿刺入路治疗复杂股浅动脉慢性闭塞性病变可行性分析  

Feasibility of retrograde approach via popliteal artery punctured for intraluminal recanalization of complex superficial femoral artery chronic total occlusions

作　　者：厉建林 王磊[1] 苗仁英 苗超峰[1] 陈宁恒[1] 张闯[1] 李萌[1] 张秀丽[1] 宋燕[1] 郭学利[1] LI Jian-lin;WANG Lei;MIAO Ren-ying;MIAO Chao-feng;CHEN Ning-heng;ZHANG Chuang;Li Meng;ZHANG Xiu-li;SONG Yan;GUO Xue-li(Deparment of Vascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院血管外科,河南郑州450052

出　　处：《中国现代普通外科进展》2021年第8期634-639,共6页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:评估俯卧位超声引导腘动脉穿刺入路治疗复杂股浅动脉慢性闭塞性(CTO)病变的安全性和有效性。方法:回顾性分析2016年1月至2019年1月采用俯卧位超声引导腘动脉逆行穿刺入路进行血管腔内治疗的复杂股浅动脉CTO病变患者的临床资料。符合条件的126例患者中男性81例,女性45例,平均年龄(65.3±9.7)岁,共178条股浅动脉,平均闭塞长度(17.3±7.8)cm。所有患者均采用俯卧位超声引导腘动脉穿刺入路,导丝配合导管逆向开通股浅动脉闭塞段,必要时行对侧腘动脉穿刺使用SAFARI双向开通技术,建立轨道导丝并全身肝素化后行球囊并支架置入。结果:178条股浅动脉CTO病变中172条血管开通成功,技术成功率96.6%。术后踝肱指数(ABI)较术前明显提高(0.93±0.21 vs0.38±0.19,P<0.01),提高幅度>0.15;随访1年ABI值均明显高于术前(P<0.05)。191处穿刺点共31处(16.2%)发生并发症,均不需要手术或介入处理。随访1年累计一期通畅率82.8%,辅助通畅率93.1%,二期通畅率97.4%。结论:俯卧位超声引导腘动脉穿刺入路治疗复杂股浅动脉CTO病变安全有效,可作为股动脉的替代入路选择。Objective:In order to assess the safety and effectiveness of retrograde approach via ultrasound-guided popliteal artery punctured access in the prone position for endovascular treatment of complex superficial femoral artery chronic total occlusions(CTO).Methods:Retrospectively review the clinical and follow-up data of patients with complex superficial femoral artery CTO underwent endovascular recanalization via ultrasound-guided popliteal artery punctured access in the prone position from January2016 to January 2019.A total of 126 patients(male 81,femal 45,mean age of 65.3±9.7 years)met inclusion criteria with 178 superficial femoral arteries(mean occlusion length of 15.3±7.8 cm)were enrolled.All patients were arranged to treat through popliteal artery access ultrasound-guided puncture in prone postion.The guidewire and catheter through the lesion by retrograde approach,if necessary the bidirectional pass technique of SAFARI was used by contralateral popliteal artery access.Once the guidewire successfully passed the lesion systemic heparinization was implemented.After that,the balloon and stent were applied.Results:The procedure was achieved in 172 superficial femoral arteries,the technical success rate was 96.6%.After operation the ABI measurements had significantly improved than preoperative measurements(0.93±0.21 vs 0.38±0.19,P<0.01),and the increase amplitude>0.15,all the ABI measurements apparently higher than preoperative measurements during one year follow-up period(P<0.05).The total 31 complications(16.2%)were observed in 191 puncture sites,all of them were not serious with no need for adjunctive surgical or endovascular procedures.The accumulative primary patency rate,assisted primary patency and secondary patency at one year were 82.8%,93.1%and 97.4%respectively.Conclusion:Transpopliteal artery approach with ultrasound-guided in the prone position for endovascular treatment superficial femoral artery CTO was feasible,that could be considerd as an alternative approach.

关 键 词：动脉闭塞 慢性 腘动脉 超声引导动脉穿刺 血管腔内重建 

分 类 号：R543.5[医药卫生—心血管疾病] R658.3[医药卫生—内科学]