股腘动脉双入路技术在长段股浅动脉闭塞介入治疗中的应用

Application of femoropopliteal artery dual input technique in the endovascular therapy of long-segment total occlusion of superficial femoral artery

目的:探讨股腘动脉双入路技术在长段股浅动脉闭塞介入治疗中的安全性及临床应用价值。方法:采用股腘动脉双入路技术介入治疗15例长段股浅动脉闭塞患者,所有患者均在术前行双下肢动脉CTA检查明确闭塞长度及远端流出道情况,均为股动脉入路顺行开通受阻或内膜下成形无法返回真腔时联合腘动脉逆行穿刺,通路建立后对闭塞段行球囊扩张及支架置入术。比较手术前、后患者的症状及踝肱指数变化,术后每隔3个月复查踝肱指数及下肢动脉彩超。结果:15例患者均通过股腘动脉双入路技术使闭塞段动脉获得开通,技术成功率100%,路径图或多普勒引导下1次穿刺腘动脉成功9例,2、3、4次穿刺成功各2例,患者均能够耐受并未出现神经损伤等并发症。14例患者静息痛术后消失,术后踝肱指数为0.68±0.088(P<0.01),较术前明显升高(0.36±0.12)。随访时间2～16个月,1例足部溃疡未得到控制,于术后2个月行截肢手术;1例患者于术后3个月时再次出现静息痛,彩超示股动脉支架内狭窄,再行PTA术后好转;余患者随访期间未见复发。结论:股腘动脉双入路技术治疗长段股浅动脉闭塞安全性高、患者耐受性好,近期疗效确切,为介入治疗复杂下肢动脉硬化闭塞提供了新思路。

Objective：To study the safety and effect of endovascular therapy of long-segment total occlusion of superficial femoral artery using femoropopliteal artery dual input technique.Materials and Methods：Fifteen patients were treated with endovascular therapy of long-segment total occlusion of superficial femoral artery using femoropopliteal artery dual input technique.CTA examination of lower limb were performed for all patients which can be evaluated the length of occlusion segment and distal outflow tract.All patients underwent retrograde popliteal artery puncture and the balloon angioplasty and the stent implantation were performed in all cases.The ankle/braehial index（ABI） and symptoms post-treatment and pre-treatment were analyzed.Ankle-brachial index and Doppler ultrasound of lower extremity arteries were peformed every 3 months after endovascular therapy.Results：Fifteen cases with long-segment total occlusion of superficial femoral artery were recallalized,with technical success rate of 100%.The symptoms of rest pain disappeared in 14 cases.The ABI was 0.68±0.088 for post-treatment and 0.36±0.12 for pretreatment respectively（t=18.62,P〈0.01）.During 2～16 months＇ follow up,1 case of foot ulcers has not been controled,undergoing amputation 2 months after interventional treatment;1 case recurrence of rest pain 3 months af-ter therapy,Doppler ultrasound showing femoral artery stent restenosis,which was treated successfully once again after balloon angioplasty.The remaining patients with no recurrence.Conclusion：It is safe and effective to apply femoral artery combined with popliteal artery puncture technique to treat long-segment total occlusion of superficial femoral artery.It is a new idea for interventional treatment of lower extremity arterial occlusion.