下肢动脉硬化闭塞症术后再闭塞的治疗

Treatment of re-occlusion after surgery for arteriosclerosis obliterans in lower limbs

目的评价导管溶栓联合球囊扩张或支架血管成形术在下肢动脉硬化闭塞症(ASO)术后再闭塞的治疗效果。方法 2012年1月至2013年10月对35例治疗后再闭塞的ASO患者先采用溶栓导管动脉内接触性溶栓,再选择性联合血管形成术治疗。11例患者近膝关节处股浅动脉或腘动脉病变,应用VIABAHN覆膜支架治疗。观察溶栓效果和动脉再通情况。结果本组溶栓总有效率达92.3%,治疗后皮肤温度回升,静息痛消失,无垃圾脚发生,但有1例轻度脑栓塞。踝肱指数由术前的0.18±0.07升高至0.82±0.05,手术前后比较差异有统计学意义(P<0.01)。11例患者使用VIABAHN覆膜支架,术后3个月复查均通畅,术后6个月1例再闭塞,予支架内球囊扩张后血流通畅。结论动脉内溶栓导管接触性溶栓,能够溶解大部分血栓,暴露真实病变,减少支架数目、缩短支架长度,结合新型覆膜支架VIABAHN动脉成形术,降低血管再狭窄风险,提高保肢率。

Objective To evaluate the efficacy of catheter-directed thrombolysis combined with balloon angioplasty or stent implantation for patients with postoperative re-occlusion in arteriosclerosis obliterans(ASO). Methods Frome January 2012 to October 2013, catheter-directed thrombolysis combined with angioplasty was selectively performed in 35 ASO patients who underwent postoperative re-occlusion. The new stent graft of GORE VIABAHN was used in 11 patients to treat lesions in superficial femoral artery near the knee joint or in the popliteal artery. The efficacy of thrombolysis and recanalization of the artery were observed. Results The total successful rate of thrombolysis was 92.3%. After treatment, the skin temperature improved and rest pain dissapeared without symptom of garbage feet. There was one case with mild cerebral embolism. The ankle-brachial index(ABI) increased from 0.18±0.07 preoperatively to 0.82±0.05 postoperatively, the difference was statistically significant(P<0.01). Three months after operation, the patency rate was 100% in 11 patients who underwent VIABAHN stent graft implantation. Re-occlusion occurred in one case 6 months after operation. The artery was patent after balloon angioplasty inside the stent. Conclusions Catheter-directed thrombolysis are capable to dissolve most of the thrombus, exposure the real lesions, reduce the number of stents implanted and shorten the stent length.Catheter-directed thrombolysis combined with new stent graft VIABAHN implantation can reduce the risk of restenosis and improve limb salvage rate.