机械性血栓清除系统联合覆膜支架治疗股-腘动脉人工血管搭桥术后再闭塞的疗效  

Efficacy of mechanical thrombectomy system combined with stent-graft in the treatment of reocclusion after femoral-popliteal artery bypass surgery

作　　者：周密 田轩[1] 贾伟[1] 蒋鹏[1] 程志远[1] 张蕴鑫 李金勇 刘笑 田晨阳[1] 刘建龙[1] Zhou Mi;Tian Xuan;Jia Wei;Jiang Peng;Cheng Zhiyuan;Zhang Yunxin;Li Jinyong;Liu Xiao;Tian Chenyang;Liu Jianlong(Department of Vascular Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院血管外科,北京100035

出　　处：《血管与腔内血管外科杂志》2023年第4期395-398,408,共5页Journal of Vascular and Endovascular Surgery

基　　金：北京积水潭医院院级科研基金-自然基金培育计划(ZR202308);北京积水潭医院人才培养计划“学科新星”(XKXX202207)。

摘　　要：目的 探讨机械性血栓清除系统联合覆膜支架治疗股-腘动脉人工血管搭桥术后再闭塞的疗效。方法 收集2018年12月至2021年6月北京积水潭医院收治的8例采用机械性血栓清除系统联合覆膜支架治疗股-腘动脉人工血管搭桥术后再闭塞患者的临床资料,统计手术成功率、手术时间、住院时间、术中出血量、手术并发症、术前与术后的踝肱指数(ABI)和卢瑟福分级,观察术后12个月的动脉通畅率、靶血管再干预率。结果 8例患者手术成功率均为100%,手术时间为(68±19)min,术中出血量为(185.3±59.1)ml,住院时间为(8.0±2.4)d 1例患者术中出现远端动脉栓塞,经导管抽吸后血流恢复。术后ABI为(0.77±0.10),高于术前的(0.27±0.05),差异有统计学意义(P﹤0.05)。术后卢瑟福分级较术前明显改善(P﹤0.05)。8例患者均门诊随访至少12个月,随访率为100%,术后12个月的动脉通畅率、靶血管再干预率分别为87.5%(7/8)、0。1例高龄患者随访过程中出现间歇性跛行,彩色多普勒超声示支架内狭窄率﹥50%,经强化抗血小板抗凝、扩血管保守治疗后好转。结论 股-腘动脉人工血管搭桥术后再闭塞病变中使用机械性血栓清除系统联合覆膜支架是一种安全有效的治疗方法,临床效果较为满意。Objective To investigate the curative effect of a mechanical thrombectomy system combined with stentgraft in the treatment of reocclusion after femoral-popliteal artery artificial vascular bypass grafting.Method The clinical data of 8 patients with reocclusion after femoral-popliteal artery bypass grafting who underwent mechanical debulking combined with stent-graft from December 2018 to June 2021 in Beijing Jishuitan Hospital were collected.The operation success rate,operation time,hospitalization time,intraoperative blood loss,operation complications,preoperative and postoperative ankle-brachial index(ABI),and Rutherford classification were counted.The arterial patency rate and target vessel reintervention rate 12 months after the operation were also observed.Result The success rate of the operation in all 8 patients was 100%,the average operation time was(68±19)min,the average intraoperative blood loss was(185.3±59.1)ml,and the average hospitalization time was(8.0±2.4)d.One patient had distal arterial embolism during the operation,and the blood flow was restored after catheter aspiration.The ABI after the operation was(0.77±0.10),higher than that before the operation(0.27±0.05),the difference was statistically significant(P<0.05).The postoperative Rutherford grade was significantly improved compared with preoperative(P<0.05).All 8 patients were followed up for at least 12 months in the in the outpatient department,the follow-up rate was 100%.12 months after the operation,the arterial patency rate and the target vessel reintervention rate was 87.5%(7/8)and 0 respitively.One elderly patient developed intermittent claudication during follow-up,color Doppler ultrasound showed that the stent stenosis>50%,improved after intensive antiplatelet anticoagulation and vasodilator conservative treatment.Conclusion The use of Rotarex mechanical thrombectomy system combined with Viabahn stent-graft is a safe and effective treatment for reocclusion after femoro-popliteal artery bypass grafting,and the clinical effect is

关 键 词：血栓切除术 覆膜支架 人工血管搭桥术后再闭塞 

分 类 号：R543[医药卫生—心血管疾病]