周围动脉急慢性闭塞疾病的综合介入治疗

Percutaneous transluminal treatment for stenotic and occlusive lesions of peripheral artery

目的:探讨血管内局部溶栓,血栓碎吸,经皮血管成形(percutaneous transcatheter angioplasty,PTA)和内支架置入,联合治疗急慢性动脉闭塞性疾病的临床效果和应用价值。方法:周围动脉阻塞接受了介入治疗共259例。急性动脉血栓性闭塞58例,局部溶栓+血栓碎吸;动脉狭窄合并急性血栓闭塞61例,局部溶栓+PTA;慢性动脉狭窄阻塞140例,局部溶栓+PTA+内支架置入。结果:全组总的介入治疗成功率98.8%(256/259)。局部溶栓+血栓碎吸成功率100%(58/58),血管完全开通91.4%(53/58),部分开通8.6%(5/58)。局部溶栓+PTA治疗成功率85.2%(52/61),9例辅以内支架置入治疗获得成功;PTA+内支架置入治疗成功率97.8%(137/140)。并发症发生率7.7%(20/259),局部溶栓+血栓碎吸8.6%(5/58),局部溶栓+PTA14.8%(9/61),PTA+内支架置入4.2%(6/140)。结论:经皮经腔综合介入治疗周围动脉急慢性闭塞疾病是安全有效的方法。恰当选用局部溶栓、血栓碎吸、PTA和内支架置入技术并个体化有机地组合应用,可显著提高成功率和疗效并减少并发症发生。

Objectlve：To study the effect of the local thrombolysis（the thromboclasis）, PTA, and stem implantation on treating acute and chronic arterial occlusion. Methods： Percutaneous transluminal treatment was performed in peripheral arterial occlusion （259 patients）. Local thrombolysis were performed in 58 patients suffering from acute arterial occlusion. Local thrombolysis and PTA was performed in 61 patients suffering from arteriostenosis combined with acute occlusion. Local thrombolysis, PTA and stem implantation were performed in patients suffering from chronic arteriostenosis occlusion. Results： Total success rate was 98.8 % （256/259）. The success rate in local thrombolysis group was 100%（58/58）, with 91.4% （53/58）of the blood vessels restored, 8.6% （5/58） of the blood vessels partial/y restored. The success rate in local thrombolysls and PTA group was 85.2%（52/61）. The success rate in PTA and stentt implantation group was 97.9%（137/140）. The total complication rate was 7.7% （20/259）, of them the local thrombolysis group accounting for 8.6% （5/58）, the local thrombolysis and PTA group accounting for 14.8% （9/61）, the PTA and stem implantation group accounting for 4.2%（6/140）. Conclusion：The percutaneous transluminal treatment was a safe and effective option. Right application of local thrombolysis, PTA, and stent implantation can help to improve primary results of treatment and reduce the complication rate.