动脉支架成形联合动脉置管溶栓对下肢动脉闭塞治疗作用

Percutaneous transluminal angioplasty combined with intraarterial thrombolytic therapy for lower limbs artery occlusion

目的评价动脉支架成形联合动脉置管溶栓对下肢动脉闭塞疗效与畅通率。方法经CT造影证实髂股动脉长段(>10cm)狭窄闭塞,腘动脉以远及分支广泛闭塞,无良好流出道。患者共45例52条肢体(Fontaine分期均为III～IV),其中男28例,女性17例;年龄49～84岁,平均68.5±15.5。所有患者都成功开通闭塞的股髂动脉并植入支架无截肢,无死亡,其中27条肢体同时行动脉置管溶栓术。分为支架植入联合置管溶栓治疗组27条肢体和单纯支架植入对照组25条肢体,于术后比较两组临床症状是否改善,ABI的变化及垃圾脚发生率。足背动脉或胫后动脉恢复搏动比率。结果与对照组相比,治疗组患者临床症状明显改善或消失提高24.29%。垃圾脚发生率降低75%,踝/肱指数比对照组平均提高0.30±0.07。足背或胫后动脉恢复搏动率提高25.85%。两组病人临床治疗效果有明显差异(P<0.05)。其短、中期通畅率令人满意,但长期通畅率仍需继续随访观察。结论动脉支架成形联合动脉置管溶栓是治疗下肢髂股动脉长段狭窄闭塞,无良好流出道的动脉闭塞疾病的一种创伤小,疗效好、畅通率高的治疗方法。

Objective To evaluate the safety and efficacy of intraarterial thrombolytic therapy in combination with percutaneous transluminal angioplasty for lower limbs artery occlusion. Methods： Iliac-femoral artery disease without good widely block outflow tract were conformed by CT angiography. Objective 45 cases with 52 lesions （Fontaine stage III- IV）, 28 males and 17 females, aged 49-84, average 68.5 ± 15.5. All lesions were successfully opened and stents were placeed without amputation and death. 27 limbs got catheter arterial thrombolysis simultaneously. Improved clinical symptoms, the change of rubbis feet, arterial restore pulsations ratio and ABI were compared between the two groups. Results： Compared with the control group, the experimental group had higher clinical symptoms improvement, lower garbage feet incidence, higher ABI increase and higher dorsal artery of foot or posterior tibial arterial recovery rate. Patients＇ clinical treatment effect in two groups was obviously different （P 〈 0.05）. The short, medium patency rate was satisfactory, but the long-term patency rate need continued follow-up. Conclusion： Intraarterial thrombolytic therapy in combination with percutaneous transluminal angioplasty is fit for long narrow iliac-femoral artery without good outflow. It is an effect treatment.