下肢多节段动脉硬化闭塞症的联合治疗

Composite therapy for critical extremity multilevel atherosclerotic occlusive disease

目的探讨下肢多节段动脉硬化闭塞症治疗方法及临床疗效。方法2004年3月至2005年11月,采用髂动脉球囊扩张和支架植入结合动脉旁路术、股深动脉成形术或自体骨髓干细胞移植术治疗下肢多节段动脉硬化闭塞症17例(19条肢体),术前踝肱指数(ABI)为(0.26±0.13),术前常规行血管彩超及CTA检查评价下肢动脉病变情况。结果髂动脉球囊扩张和支架植入19条,股深动脉成形11条,股-动脉人工血管转流术12条,自体骨髓干细胞移植3条,均获得成功。均未出现严重并发症。术后ABI(0.64±0.17)(P<0.05,t检验),随访期间,4例残余间歇性跛行,3例术后3个月行干细胞移植术后症状明显好转。结论多方法联合是治疗多节段多平面下肢动脉硬化闭塞症的有效方法;股深动脉的病变范围与手术治疗效果密切相关;术前正确评价股深动脉的通畅程度十分重要。

Objective To study the composite therapy for multilevel atherosclerotic occlusive disease. Methods From March 2004 to December 2005, intraoperative iliac angioplasty and stenting combined with simultaneous vascular surgery and postoperative autologous bone stem cell transplantation were performed on 17 patients with critical multilevel atherosclerotic occlusive disease. Mean preoperative ankle - brachial index （ABI） was 0.26 ± 0.13. Results Surgical procedures were technically successful in all patients. There was no severe postoperative morbidity or mortality. Postoperative ABI was 0.64 ± 0.17 （ P 〈 0.05）. During the period of follow - up, no patients had rest pain. Four patients had intermittent claudication and 3 of them were subjected to autologous bone stem cell transplantation 3 monthes after the operation. Conclusion Simultaneous intravascular interventional therapy combined with vascular surgery are effective in patients with severe and multilevel atherosclerotic occlusive disease. Preoperative assessment of the disease is important.