下肢动脉硬化性闭塞继发血栓形成腔内外联合手术临床研究(附86例病例报告)

The clinical study on endovascular and extravascular combination method for the treatment of the patients with lower extremity arteriosclerosis obliterans with thrombosis

目的总结腔内外联合一站式手术解决下肢动脉硬化性闭塞继发血栓的治疗经验。方法对86例下肢动脉硬化性闭塞继发血栓的临床资料进行回顾性分析。结果 86例患者均在DSA下行腔内外联合手术,根据病变位置不同及每个患者的具体情况采取最有利的个性化手术治疗,植入支架64枚,人工血管转流23例次,86例患者均伴有远端流出道或流入道病变,均在术中使用球囊扩张。86例患者手术均获得成功,保肢率100%,1例术后3天死于肺梗。术后随访3个月至2年,随访率为93%(80/86),疗效满意。结论根据下肢动脉硬化性闭塞继发血栓形成的部位及狭窄或闭塞程度的不同,所以不能采取固定的模式去处理每位患者,腔内外联合一站式手术因为可以根据手术中具体情况而及时修订手术方向,是治疗下肢动脉硬化性闭塞继发血栓形成的有效手段。

Objective To summarize the clinical experience on endovascular and extravascular combination method for the treatment of the patients with lower extremity arteriosclerosis obliterans with thrombosis. Methods A retrospective analysis was made for 86 paitients with lower extremity arteriosclerosis obliterans with thrombosis underwent endovascular and extravascular combination method. Results 86 patients underwent endovascular and extravascular combination method under DSA according to the speciifc circumstances and the different lesion locations. 86 patients with lesions of distal outflow tract or inflow tract underwent balloon dilation with 64 stents implantation,of which 23 did artificial blood vessel bypass without any operative complications. The limb salvage rate was 100%. One patient died of pulmonary infarction after operative third day. The curative effect of all patients is satisfactory by follow-up from 3 months to 2 years with the follow-up rate of 93%. Conclusions Endovascular and extravascular combination method under DSA according to the speciifc circumstances and the different lesion locations is an effective modality for the treatment of the paitients suffering from lower extremity arteriosclerosis obliterans with thrombosis.