导管直接溶栓减容在下肢动脉TASCⅡC、D型治疗中的应用价值  

Application value of catheter-direct thrombolysis volume reduction in TASCⅡC and D type treatment of the lower limb artery

作　　者：李善凯 胡效坤[2] LI Shankai;HU Xiaokun(Department of Interventional Medicine,Linyi Central Hospital,Linyi,Shandong Province 276400,China;Interuentional Medical Center,the Affiliated Hospital of Qingdao University,Qingdao,Shandong Province 266000,China)

机构地区：[1]临沂市中心医院介入医学科,山东临沂276400 [2]青岛大学附属医院介入医学中心,山东青岛266000

出　　处：《实用放射学杂志》2022年第6期991-993,1002,共4页Journal of Practical Radiology

摘　　要：目的评价导管直接溶栓(CDT)在下肢动脉硬化闭塞症(ASO)泛大西洋学会联盟(TASC)ⅡC、D型中的有效性、安全性及临床应用的价值.方法收集采用CDT减容治疗后再行血管成形术治疗202例下肢ASO TASCⅡC、D型慢性缺血患者的资料,评价溶栓有效率、安全性等.结果198例患者成功实施CDT治疗,4例患者CDT置管失败,成功率98%,其中3例患者CDT失败原因为病变闭塞段较长,开通过程误入夹层,另1例因术中烦躁,CDT置管失败.198例中184例溶栓减容有效,溶栓有效率为92.9%(184/198).动脉闭塞病变平均长度由术前(156±22)mm经CDT减容后病变缩短为(102±18)mm(P<0.01),从而减少支架置入数量.178例患者病变由TASCⅡC、D型改善为B、C型,再行支架置入球囊扩张成形治疗.踝-肱指数(ABI)由术前0.28±0.12显著升高至术后0.67±0.21(P<0.01).CDT期间总并发症发生率为21.2%,其中较为严重的为1例颅内出血、1例消化道出血,经进一步检查确诊出血部位分别为颅内动脉瘤出血和消化道溃疡出血,经专科治疗后改善,无死亡病例.结论CDT减容在TASCⅡC、D型治疗中,安全有效,降低支架使用数量和治疗费用,临床应用价值极高.Objective To evaluate the effectiveness,safety,and clinical values of catheter direct thrombolysis(CDT)in Trans-Atlantic Inter Society Consensus(TASC)Ⅱ type C and D of lower limb arteriosclerosis obliterans(ASO).Methods A total of 202 patients with chronic ischemia of ASO TASCⅡ type C and D who underwent angioplasty after CDT volume reduction treatment were selected to evaluate the effective and safety of the therapy.Results 198 patients were successfully treated with CDT.CDT catheterization failed in 4 patients,the success rate was 98%.3 patients failed because of a long occlusion segment and misplacement into the dissection during the opening process of thrombolytic therapy.1 patient was irritable during the operation,which led to the failure of thrombolytic therapy.The effective rate of thrombolysis was 92.9%(184/198).After CDT volume reduction,the mean length of arterial occlusive lesions was shortened from(156±22)mm to(102±18)mm(P<0.01),thus reducing the number of stents.The TASCⅡ classification of 178 patients was improved(C and D to B and C),and then stent implantation ballon dilatation was performed.The ankle brachial index(ABI)increased significantly from 0.28±0.12 preoperatively to 0.67±0.21 postoperatively(P<0.01).The total complication rate during CDT treatment was 21.2%,2 patients happened with serious intracranial hemorrhage and gastrointestinal hemorrhage respectively.F urther examination showed that the bleeding were due to intracranial aneurysm and gastrointestinal ulcer respectively,which were improved after treatment.Conclusion CDT volume reduction is safe and effective in the treatment of TASCⅡ type C and D which can reduce the number of stents used and the treatment cost,thus it has extremely high clinical application value.

关 键 词：导管直接溶栓 减容 下肢动脉硬化闭塞症 

分 类 号：R815[医药卫生—放射医学] R543.5[医药卫生—临床医学]