Rotarex机械血栓清除术在急性下肢缺血中的应用  

The Application of Rotarex Mechanical Thrombectomy in the Treatment of Acute Limb Ischemia

作　　者：赵辉[1] 胡红耀[1] 吴振中[1] 饶珉[1] 任权 吴晶晶[1] 王英 冯军伟 李忠 刘健伟 ZHAO Hui;HU Hongyao;WU Zhenzhong(Department of Interventional Radiology,Renmin Hospital of Wuhan University,Wuhan,Hubei Province 430060,P.R.China)

机构地区：[1]武汉大学人民医院放射介入科,430060

出　　处：《临床放射学杂志》2021年第6期1193-1197,共5页Journal of Clinical Radiology

基　　金：湖北省自然科学基金资助项目(编号:2016CFB695)。

摘　　要：目的评价Rotarex经皮机械血栓清除术(PMT)治疗急性下肢缺血(ALI)的应用价值。方法回顾性分析采用Rotarex系统PMT治疗的38例ALI患者的临床资料,包括动脉硬化基础上的血栓形成25例(其中股浅动脉支架内闭塞5例),房颤引起心房血栓脱落导致的动脉栓塞13例。患者均有突然加重的不同程度下肢缺血症状,经临床和影像学检查明确诊断。术前Rutherford分级3~5级,踝肱指数0.38±0.19。观察手术疗效、不良反应及并发症情况。术后随访评估临床症状及血管通畅情况。结果患者均顺利完成PMT治疗。5例支架内闭塞患者联合药物涂层球囊扩张治疗。8例辅助经导管接触性溶栓治疗。19例联合普通球囊扩张,14例植入支架。治疗后踝肱指数显著增加到0.92±0.16(t=12.72,P<0.05)。36例获得技术成功,技术成功率94.7%。36例临床有效,Rutherford分级改善。PMT术中发生血管夹层1例,远端动脉栓塞2例。随访1年期间,4例下肢缺血症状复发,1例术后9个月死于心功能不全。结论Rotarex系统PMT治疗ALI安全有效,具有重要的临床应用价值。Objective To evaluate the clinical application of Rotarex percutaneous mechanical thrombectomy(PMT)in the treatment of acute limb ischemia(ALI).Methods Data of 38 patients with ALI treated by Rotarex PMT were retrospectively analyzed,including 25 cases of arterial thrombosis based on arteriosclerosis(5 cases of arterial thrombosis in the superficial femoral artery stent)and 13 cases of arterial embolism caused by atrial fibrillation.All patients had symptoms of lower extremity ischemia which suddenly worsened and the diagnosis was confirmed by clinical and imaging examinations.Rutherford score was 3-5 and mean of ankle brachial index was 0.38±0.19 before operation.The post-operativeefficacy,adverse reactions and complications were observed.Follow-up included evaluation of the symptoms and vascular patency.Results All patients were successfully treated by PMT.Additional catheter-directed thrombolysis was performed in 8 patients,plain old balloon angioplasty was performed in 19 patients,stent was implanted in 14 patients and drug-coated balloon dilatation was performed in 5 patients with in-stent occlusion.The ankle brachial index significantly increased to 0.92±0.16(t=12.72,P<0.05)after operation.The technique was successful in 36 patients and the technique success rate was 94.7%.Thirty-six patients were clinically effective with improvement of Rutherford grade.During PMT,there were 2 cases of distal arterial embolism and 1 case of vascular dissection.During the 1-year follow-upperiod,the lower extremity ischemic symptoms recurred in 4 patients.One patient died of cardiac insufficiency 9 months after operation.Conclusion Rotarex PMT is safe and effective in the treatment of ALI and has important clinical application value.

关 键 词：急性肢体缺血 血栓形成 血栓栓塞 机械取栓 介入治疗 

分 类 号：R654.4[医药卫生—外科学]