髂股动脉闭塞性病变的介入开通治疗

Interventional recanalized therapy for occlusive lesion in iliac-femoral arteries

目的:探讨髂股动脉闭塞性病变介入开通治疗的策略及临床疗效。材料与方法:2001年2月～2006年2月我院介入病房收治的42例经DSA证实为髂动脉和/或股动脉闭塞的病人,男30例,女12例,年龄35～82岁。闭塞段长度2～30cm,发病时间10小时～30年。术中分别采用经导管动脉内溶栓、导丝机械开通、PTA、支架置入术等方法,术后给予抗凝及抗炎治疗1周,随访2年。结果:本组中溶栓治疗26例,其中11例术中溶栓后即可见闭塞段开通,7例继续溶栓3～7天后闭塞段血流恢复正常。15例作为机械开通的后续治疗手段。机械开通31例,PTA33例,支架置入31例。术中未出现血管破裂、穿孔等严重并发症。术后所有病人下肢缺血症状明显减轻或消失。踝肱指数由术前的0.34±0.14增加至出院前的0.65±0.095(P<0.001)。随访期间1例病人于术后15个月死于急性心肌梗死,另外11例再次出现下肢缺血症状,其余30例症状无复发,血管超声复查提示管腔通畅、血流良好。结论:髂股动脉闭塞性病变介入开通治疗创伤小、疗效好,具有良好的临床应用价值。

Objective： To investigate the interventional recanalized therapeutic strategy and efficacy of occlusive lesion in iliac-femoral arteries. Materials and Methods： During Feb 2001 to Feb 2006, 42 patients（30 male and 12 female） whose arterial occlusive lesions in iliac artery and/or femoral artery had been diagnosed by DSA accepted interventional therapies. Among the 42 patients, the length of occlusive arteries ranged from 2cm to 30cm, the interval between symptom emerging and interventional therapeutic beginning ranged from 10 hours to 30 years. The interventional therapeutic tools included local thrombolytic therapy through endoarterial catheter, artery recanalization by guide wire, PTA and stent. Results： Immediate technical success was 97.6% （41/42 cases）. The arterial occlusions were resolved successfully （local thrombolytic therapy in 26 cases, recanalization by guide wire in 31 cases, PTA in 33 cases and 60 stents in 31 cases）. There were no severe complications （such as angiorrhexis, perforation） during interventional process. The symptoms of lower limb ischemia were palliated or vanished in all patients and ABI increased from 0.34：1=0.14 to 0.65：1=0.095（P〈0.001） after interventional therapy. During the follow-up （24 months）, 11/42 （23.2%） occlusions of an iliac or femoral stent occurred （treated with local intra-arterial thrombolysis, PTA and stent）. One patient died of myocardial infarct 15 months post-operation. Conclusions： Interventional recanalized therapy is an effective and safe therapy for occlusive lesion in iliac-femoral arteries.