透视引导下逆向穿刺技术在股腘动脉硬化闭塞症治疗中的应用  

Application of Fluoroscopy-guided Retrograde Intervention for Femoropopliteal Arteriosclerosis Oblite-rans

作　　者：牛振凯 曹立华 孙岩 NIU Zhen-kai;CAO Li-hua;SUN Yan(Department of Surgery,Binzhou Hospital of Traditional Chinese Medicine,Binzhou 256600,Shandong,China;Department of Vascular Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong,China)

机构地区：[1]滨州市中医医院外科,山东滨州256600 [2]山东第一医科大学附属省立医院血管外科,山东济南250021

出　　处：《中国现代手术学杂志》2021年第5期366-370,共5页Chinese Journal of Modern Operative Surgery

基　　金：山东省中医药科技发展计划项目(2019-0303);山东省医药卫生科技发展计划项目(2018WS273)。

摘　　要：目的探讨透视引导下逆向穿刺技术在股腘动脉硬化闭塞症治疗中的应用效果。方法选择2019年3月至2021年3月应用透视引导下逆向穿刺技术治疗的35例股腘动脉硬化闭塞症患者作为研究对象,记录逆向穿刺技术成功率、并发症发生率、手术前后患肢踝肱压力指数和患侧足部温度变化。结果35例患者中,13例(37.14%)逆穿股浅动脉远端,8例(22.86%)逆穿腘动脉远端,6例(17.14%)逆穿胫后动脉,4例(11.43%)逆穿胫前动脉,4例(11.43%)逆穿足背动脉。所有患者均成功实施透视引导下逆向穿刺技术并开通闭塞病变,其中22例在造影引导下穿刺,10例在路径图引导下穿刺,3例在管壁钙化显影引导下穿刺。24例患者导丝经真腔通过病变部位,11例患者导丝经内膜下返回真腔通过病变部位。30例患者行支架置入术,5例患者单纯行球囊扩张术。术后彩超检查未见穿刺点出血、皮下血肿、假性动脉瘤等穿刺并发症。术后踝肱压力指数和患侧足部温度均较术前明显提高,差异有统计学意义(P<0.05)。结论透视引导下逆向穿刺技术治疗下肢股腘动脉硬化闭塞症效果显著,可作为顺行介入治疗失败时首选补救措施。Objective To investigate the effect of fluoroscopy-guided retrograde puncture technique in the treatment of femoropopliteal atherosclerosis obliterans.Methods A total of thirty-five patients with femoropopliteal atherosclerosis obliterans treated with fluoroscopy-guided retrograde puncture technique in our hospital from March 2019 to March 2021 were enrolled and analyzed retrospectively.The success rate of the retrograde intervention,complication rate,ankle-brachial pressure index of the involved limb and temperature of the involved foot were observed and compared between those before and after the treatment.Results Among the 35 patients,the puncture position was located in the distal end of the superficial femoral artery in 13 cases(37.14%),the distal popliteal artery in 8 cases(22.86%),the posterior tibial artery in 6 cases(17.14%),the anterior tibial artery in 4 cases(11.43%)and the dorsal foot artery in 4 cases(11.43%).Fluoroscopy-guided retrograde puncture technique was performed successfully,including 22 cases under angiographic guidance,10 under road map guidance and 3 cases under calcification of tube wall.And occluded lesions of femoropopliteal artery were recanalization in all patients.Stenting was performed in 30 patients and balloon dilatation was in 5 patients.There were no puncture complications such as bleeding at the puncture point,subcutaneous hematoma and pseudoaneurysm.Compare to poster-operation,the postoperative ABI and temperature of the involved foot were increased,and there was significant difference between them(P<0.05).Conclusion The fluoroscopy-guided retrograde intervention is effective for femoropopliteal atherosclerosis oblit-erans,and it can be the preferred remedial measure when antegrade recanalization failed.

关 键 词：动脉硬化闭塞症 股腘动脉 逆向穿刺 介入治疗 

分 类 号：R654.4[医药卫生—外科学]