下肢动脉减容术中的远端栓塞保护  

Distal embolic filter protection during debulking treatment of peripheral artery disease

作　　者：任碧晨 李小燕[2] 刘浩 蒋小浪 鞠帅[2] 陈斌 蒋俊豪 石赟 马韬 林长泼 郭大乔 徐欣 董智慧 符伟国 Ren Bichen;Li Xiaoyan;Liu Hao;Jiang Xiaolang;Ju Shuai;Chen Bin;Jiang Junhao;Shi Yun;Ma Tao;Lin Changpo;Guo Daqiao;Xu Xin;Dong Zhihui;Fu Weiguo(Department of Vascular Surgery of Zhongshan Hospital,Fudan University,Shanghai 200030,China;Department of Vascular and Wound Treatment Center,Jinshan Hospital,Fudan University,Shanghai 200540,China)

机构地区：[1]复旦大学附属中山医院血管外科,上海200030 [2]复旦大学附属金山医院血管和创面诊疗中心,上海200540

出　　处：《中华普通外科杂志》2022年第9期675-678,共4页Chinese Journal of General Surgery

基　　金：上海市优秀学术带头人(19XD1401200)。

摘　　要：目的探讨下肢动脉准分子激光消融(excimer laser ablation,ELA)和机械性血栓清除(percutaneous mechanical thrombectomy,PMT)术中远端栓塞保护(distal embolic filter protection,DEFP)的应用策略。方法收集2019年10月至2021年8月下肢动脉ELA或PMT术中进行DEFP的29例患者临床资料,回顾分析保护伞的选择、应用指征及策略,分析较大栓子捕获的高风险因素。结果29例患者中,男21例,女8例,年龄(70.3±11.0)岁。共计29条肢体,32处病变:支架内再狭窄(ISR)5处,血栓形成或栓塞10处,慢性完全闭塞性病变(CTO)17处,根据病变性质选择减容装置。保护伞释放与回收技术成功率100%,栓子总体捕获率77.3%,较大栓子捕获率36.4%,术中远端栓塞发生率3.4%。ELA治疗高度钙化CTO病变或长段ISR病变时,较大栓子捕获率均高达60.0%,且前者较治疗非高度钙化CTO病变差异有统计学意义(P<0.05)。结论下肢动脉ELA和PMT术中选择性应用保护伞,对预防远端栓塞具有重要意义。Objective To discuss the strategies of distal embolic filter protection(DEFP)during excimer laser ablation(ELA)or percutaneous mechanical thrombectomy(PMT)in treatment of peripheral artery disease.Methods Clinical data of 29 patients undergoing ELA or PMT under the DEFP from Oct 2019 to Aug 2021 were retrospectively collected to analyze the strategies of DEFP and high-risk factors of capturing clinically significant macrodebris.Results There were 21 males and 8 females,aged(70.3±11.0)years with 32 lesions(29 limbs)including 5 in-stent restenosis(ISR),10 thrombosis and 17 chronic total occlusion(CTO).The technical success rate of DEFP device release and recovery was 100%.The overall debris capture rate was 77.3%and the macrodebris capture rate was 36.4%.Even with DEFP the distal embolization(DE)incidence was 3.4%.When ELA for CTO with severe calcification or long-segment ISR lesions,the capture rate of macrodebris was as high as 60.0%,and the former was significantly higher than ELA for CTO without high calcification lesions(P<0.05).Conclusion ELA or PMT under the DEFP in treatment of peripheral artery disease appears to be of great significance in preventing DE.

关 键 词：动脉闭塞性疾病 血管外科手术 准分子激光消融 经皮机械性血栓清除 远端栓塞保护装置 

分 类 号：R654.3[医药卫生—外科学]