Rotarex经皮机械血栓切除系统治疗下肢动脉人工血管转流术后移植物闭塞的临床分析  

Clinical analysis of Rotarex percutaneous mechanical thrombectomy for treatment of lower extremity artificial bypass occlusion

作　　者：刘钊[1] 冯海[1] 陈学明[1] 于宏志[1] 朱仁明[1] 高翔[1] 张喆[1] 刘彬[1] Liu Zhao;Feng Hai;Chen Xueming;Yu Hongzhi;Zhu Renming;Gao Xiang;Zhang Zhe;Liu Bin(Department of Vascular Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院血管外科,北京100050

出　　处：《国际外科学杂志》2022年第11期752-756,I0004,共6页International Journal of Surgery

基　　金：首都卫生发展科研专项(2020-2-1102)。

摘　　要：目的分析应用Rotarex经皮机械血栓切除术(PMT)系统治疗下肢动脉人工血管转流术后移植物闭塞的安全性和有效性。方法回顾性分析2016年1月—2020年12月首都医科大学附属北京友谊医院血管外科收治的19例下肢动脉人工血管转流术后移植物闭塞患者的临床资料。19例患者均应用Rotarex PMT系统治疗并随访12个月,统计分析其临床特征、手术效果以及随访情况等资料。符合正态分布的计量资料以均数±标准差(±s)表示,组间比较采用t检验。计数资料以例数和百分率(%)表示,组间比较采用χ^(2)检验。结果19例患者的技术成功率为100%。其中,采用Rotarex+置管溶栓术2例,Rotarex+球囊扩张成形术9例,Rotarex+支架置入术8例。术后踝肱指数较术前显著增加(0.82±0.14比0.47±0.11,P<0.05);下肢缺血Rutherford分级明显改善:术后重度缺血(Rutherford 4~5级)患者较术前显著减少(0例比9例,P<0.05)。其中1例发生远端栓塞,1例发生急性心肌梗死,无血管破裂、出血、感染和假性动脉瘤形成,无死亡及截肢事件。本组患者12个月一期通畅率为78.9%,免于临床驱动的靶血管重建率为89.5%。结论Rotarex PMT系统治疗下肢动脉人工血管转流术后移植物闭塞通畅率高,并发症少,是一种安全有效的治疗方式。Objective To evaluate the clinical efficacy of Rotarex percutaneous mechanical thrombectomy(PMT)for treatment of lower extremity arterial graft occlusion.Methods The clinical data of 19 patients with lower extremity arterial bypass occlusion admitted to our hospital from January 2016 to December 2020 were retrospectively analyzed.All patients were treated with Rotarex-based endovascular therapy.After 12 months follow-up,the clinical features,surgical outcomes and follow-up data were analyzed to identify effectiveness and safety of the therapy.Independent sample t test was used to analyze the measurement data of continuous normal distribution which were expressed as mean±standard deviation(±s),enumeration data were expressed as number and percentage,and the comparison between groups were analyzed by chi-square test.Results A technical success rate of 100%was demonstrated.Rotarex combined with catheter directed thrombolysis was performed in 2 cases,Rotarex combined with percutaneous transluminal angioplasty(PTA)was performed in 9 cases.Rotarex combined with stent implantation was performed in 8 patients.The Ankle brachial index significantly increased(0.82±0.14 vs 0.47±0.11,P<0.05).Critical limb ischemia(Rutherford class 4 or higher)improved significantly(0 case vs 9 cases,P<0.05).Distal embolism occurred in 1 patient and acute myocardial infarction occurred in 1 patient.There was no vascular rupture,haemorrhage,infection,pseudoaneurysm,death and amputation.Kaplan-Meier survival analysis revealed 12-month primary patency rate and freedom from clinically driven target lesion revascularization was 78.9%and 89.5%respectively.Conclusion Rotarex-based endovascular therapy is a safe and effective treatment for graft occlusion after lower extremity arterial prosthesis bypass with high patency rate and few complications.

关 键 词：血栓切除术 人工血管 移植物闭塞 血管 下肢动脉人工血管转流术 Rotarex系统 

分 类 号：R654.4[医药卫生—外科学]