介入联合血管旁路移植术治疗下肢动脉硬化闭塞症

Approach of Intervention Combined with Artificial Graft Bypass Operation on Arteriosclerosis Obliterans

目的总结介入联合血管旁路移植术治疗下肢动脉硬化闭塞症（arteriosclerosis obliterans，ASO）的临床效果。方法采用髂动脉病变段球囊扩张（PTA）及内置支架（stent）联合股→胭→小腿动脉旁路术治疗下肢动脉硬化闭塞症23例。术前均测定影肱比值（ABI）平均为0．24±0．14（0．11—0．48），并行动脉血管造影（DSA），依据患者条件选择彩超或CTA。结果行髂动脉病变段球囊扩张及内置支架术23例，股→胭动脉膝上旁路移植13例和行膝下旁路移植2例，左股→右股动脉耻骨上旁路移植5例，膝下胴→小腿动脉旁路移植3例，均取得成功。术后ABI检查为0．71±0．19（0．53～0．89），临床症状明显改善。随访期为2006年7月-2007年12月，除2例存在静息痛和不同程度间歇性跛行外，其他患者症状完全改善。结论介入联合血管旁路移植术是治疗下肢动脉硬化闭塞症的有效方法，远期效果佳。

Objective To summarize the clinical effect of intervention combined with artificial graft bypass operation on arteriosclerosis obliterans（ASO）. Methods We adopted PTA and endovascular tract with the pathological segment in arteria iliaca combined with lower extremity arterial bypass in treating 23 cases of ASO. ABI detecting and DSA were performed in all cases. Ultrasound and CTA were selected in some cases according to the condition of patients. Results 23 cases underwent PTA and endovascular tract with the pathological segment in arteria iliaca, in which 13 cases underwent arterial bypass from femoral artery to popliteal vein above knee,2 cases below knee ;5 cases underwent arterial bypass from left femoral artery to right femoral artery above public bone;and 3 cases underwent arterial bypass from popliteal vein to leg artery below knee. All cases were successful. ABI and clinical symptom were improved obviously. Only 2 cases were with rest pain and angiosclerotic myasthenia during the follow-up of 6 months. Conclusions The intervention combined with artificial graft bypass operation have good curative effect on ASO diseases. And its long-term curative effect was excellent.