37例Leriche综合征的腔内介入治疗  

Endovascular Therapy for 37 Patients with Leriche Syndrome

作　　者：厉建林 王保恒[1] 韩达 吴世勇[1] 付一群 王彦军[1] 张勇敢[1] 杨博[1] 宋燕[1] 郭学利[1] LI Jianlin;WANG Baoheng;HAN Da(Deparment of Vascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province 450052,P.R.China)

机构地区：[1]郑州大学第一附属医院血管外科,450052

出　　处：《临床放射学杂志》2023年第5期841-844,共4页Journal of Clinical Radiology

摘　　要：目的评价腔内介入治疗Leriche综合征的效果。方法回顾性分析行腔内介入治疗的37例Leriche综合征患者的临床及2年随访资料。所有患者先经肱动脉入路,尝试顺行开通闭塞段血管,一旦导丝导管通过病变段血管后,选用小直径球囊预扩张,扩张后行导管溶栓治疗,后根据造影结果行球囊扩张成形及支架置入。结果37例患者均成功完成血管重建,没有围手术期死亡。共置入44枚支架,9例未放置,17例放置1枚,7例放置2枚,3例放置3枚,1例放置4枚,其中裸支架41枚,覆膜支架3枚。治疗期间3例出现“蓝趾综合征”,1例腹股沟穿刺点皮下血肿,并发症发生率10.8%,均不严重,均能通过腔内技术解决。术后所有患者踝肱指数均较术前明显提高,随访2年一期、二期通畅率分别为89.2%、94.6%。结论腔内介入治疗Leriche综合征有效,导管溶栓减容治疗可显露血管真实病变,减少支架置入。Objective In order to evaluate the efficacy of endovascular therapy(EVT)for Leriche syndrome.Methods Retrospectively analyzed clinical and 2-year follow-up data of 37 patients with Leriche syndrome underwent EVT.In all cases the trans-brachial access was attempted for antegrade recanalization.Once the guidewire and catheter crossed the segment of occlusion,the small-diameter balloons as pre-dilatation plain angioplasty was routinely conducted.After pre-dilatation,the catheter-directed thrombolysis(CDT)therapy was used.According to the results of angiography,the balloon angioplasty and stent implantation were performed.Results The success of vascular recanalization was achieved in all patients without perioperative death.There were 9 patients without stent,17 patients 1 stent,7 patients 2 stents,3 patients 3 stents,1 patient 4 stents.All 44 stents included 41 bare stents and 3 covered stents.During therapy,there were "blue toe syndrome"in 3 cases,subcutaneous hematoma at the inguinal puncture point in 1 case.Perioperative complications were observed in 10.8%,which were not serious.All of them could be successfully managed via endovascular method.The ankle-brachial indexes of post-operation and during follow up significantly increased than pre-operation.The primary and secondary patency rates were 89.2%and 94.6%respectively,at 2-year follow-up.Conclusion EVT for Leriche syndrome was effective.CDT could reveal underlying lesions and decrease the need for stents.

关 键 词：LERICHE综合征 腔内介入治疗 置管溶栓 球囊扩张 支架 手术重建 

分 类 号：R654.3[医药卫生—外科学]