超声引导与透视引导下膝下动脉逆行穿刺在下肢动脉闭塞双向成形术中应用对比研究

Comparative study of ultrasound-guided and fluoroscopy-guided retrograde puncture of the infrapopliteal arteries in antegrade-retrograde intervention of lower extremity artery occlusion

目的比较超声引导下膝与透视引导下穿刺动脉逆行穿刺在下肢动脉闭塞双向成形术中的成功率及并发症。方法回顾性分析首都医科大学附属北京世纪坛医院自2016年5月至2019年5月因下肢动脉闭塞行双向开通术的67例病人资料,根据逆穿引导方法的不同分为超声组和透视组,其中超声组32例,透视组35例,分析两组穿刺成功率、手术成功率、通畅率及相关并发症情况。结果67例病人逆行穿刺均获得成功,超声组在平均穿刺时间及穿刺次数上均明显少于透视组(P<0.05);两组术后Rutherford分级较术前均明显改善,同时,ABI值较术前均明显升高(P<0.05);超声组与透视组6个月的一期通畅率分别为80%和76.5%,12个月的一期通畅率分别为71.4%和73.3%,两组间通畅率比较差异无统计学意义;常见并发症为穿刺点出血、血肿及穿刺血管痉挛,两组间并发症发生率差异无统计学意义。结论超声引导下穿刺较透视引导下穿刺可以明显缩短穿刺时间及减少穿刺次数,有临床应用价值。

Objective To compare the success rate and complications of ultrasound-guided retrograde puncture of infrapopliteal artery and fluoroscopy-guided puncture of lower extremity artery occlusion in antegrade-retrograde intervention.Methods A total of 67 patients who underwent antegrade-retrograde intervention for lower extremity artery occlusion from May 2016 to May 2019 in Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University were retrospectively analyzed.According to the different retrograde puncture guidance methods,32 patients were assigned into the ultrasound group and 35 patients were assigned into the fluoroscopy group.The puncture success rate,surgical success rate,patency rate and related complications were analyzed in the two groups.Results Retrograde puncture was successful in all 67 patients,and the average puncture time and average puncture times in the ultrasound group were significantly lower than those in the fluoroscopy group(P<0.05);Rutherford grading and ABI were significantly improved in both groups compared with preoperation(P<0.05);The primary patency rates of ultrasound group and fluoroscopy group were 80.0%and 76.5%at 6 months,and 71.4%and 73.3%at 12 months,respectively.The common complications were puncture site hemorrhage,hematoma and vasospasm.Conclusion Ultrasound-guided puncture can obviously shorten the puncture time and reduce the number of puncture times compared with fluoroscopy-guided puncture,which has great clinical application value.