血管腔内多种介入技术个体化联合治疗周围动脉闭塞性疾病(附736例病例分析)

United Treatment of Interventional Technique For Peripherial Arterial Obliterans Disease (Including 736 case analogy)

目的探讨周围动脉闭塞性疾病(Pripheral Arterial Obliterans Disease,PAOD),腔内溶栓术(Catheter-directed thrombolysis,CDT),机械性血栓碎吸术(Thrombus aspiration of debris,TAD),经皮血管成形术(Percutaneous transcathete angioplasty,PTA),内膜下血管成形技术(Subintimal angioplasty,SIA)和经皮血管内支架成形术(Pecutaneous transtuminl angioplasty and stenting,PTAS),个体化联合治疗的临床效果和应用价值。方法 1994年5月至2010年6月间,736例PAOD接受了介入治疗。急性动脉血栓性闭塞169例,机械性血栓碎吸+腔内溶栓;动脉狭窄合并急性血栓闭塞104例,腔内溶栓+PTA;慢性动脉狭窄阻塞463例,腔内溶栓+PTA+PTAS或腔内溶栓+SIA+PTA+PTAS。结果介入治疗有效率97.96%(721/736)。机械性血栓碎吸+腔内溶栓成功率97.04%(164/169),88.17%(149/169),部分开通8.88%(15/169),无效2.95%(5/169)。腔内溶栓+PTA成功率治疗成功率85.58%(89/104),15例辅以内支架置入治疗均获得成功。463例动脉慢性硬化闭塞患者,行腔内溶栓+PTA+PTAS,治疗成功率98.70%(457/463);其中211例应用传统的血管再通技术失败后,再采用内膜下血管成形技术(SIA),205例血管再通成功。结论多种介入技术个体化有机联合应用,显著提高了弥漫性硬化闭塞病变的再通比率。

Objective To study the clinical effect and value of the catheter-directed thrombolysis, thrombus aspiration of debris, percutaneous transcatheter angioplasty, subintimal angioplasty, percutaneous transcatheter angioplasty and stenting on treating peripheral arterial obliterans disease. Methods From May 1994 to June 2010, interventional treatment was performed in 763 patients with PAOD. Thrombus aspiration of debris and catheter-directed thrombolysis were performed in 169 patients suffering from acute arterial occlusion. Catheter-directed thrombolysis and PTA were performed in 104 patients suffering from arteriostenosis combined with acute occlusion. Catheter-directed thrombolysis and PTA and PTAS or Catheter-directed thrombolysis and SIA and PTA and PTAS were performed in 463 patients suffering from chronic arteriostenosis occlusion. Results Total success rate was 97.96%（721/736）. The success rate in Thrombus aspiration of debris and catheter-directed thrombolysis was 97.04%（164/169）, with 88.17%（149/169）of the blood vessels restored, 88%（15/169）of the blood vessels partially restored, and another 2.95%（5/169）failed. The success rate in Catheter-directed thrombolysis and PTA was 85.58%（89/104）,and 15 patients succeed in treating with endoprosthesis. The success rate was 98.70%（457/463）in 463 patients suffering from chronic arterjostenosis occlusion, treating with Catheter-directed thrombolysis and PTA and PTAS. And 205 of 211 patients who failed in traditional treatment received interventional treatment and achieved revascularizated with SIA. Conclution A variety of interventional treatments obviously increase the revascularization rate of diffuse sclerosis occlusion.