血管腔内介入治疗长段下肢动脉硬化闭塞症

Percutaneous Transluminal Angioplasty and Stent Placement for the Treatment of Long Segmental Atherosclerotic Occlusive Disease of Lower Limb

目的探讨血管腔内成形术对于TASCB、C型下肢动脉硬化性闭塞症的临床疗效。方法共40例患者(47条肢体),采用经皮穿刺股动脉,造影明确病变动脉部位及病变长度后,行球囊导管行扩张成形和血管内支架置入。术后采用彩色多普勒超声或CTA检查随访。结果47条肢体获得成功,技术成功率为96%,共置入自膨式支架31枚,16条仅行PTA。踝肱指数由术前的0.36±0.14增至术后7天的0.82±0.15;随访1～48个月,术后4例发生支架再闭塞,1例再狭窄,其余患者随访期内下肢血流通畅。讨论血管腔内成形术以其微创及安全性,可作为长段(包括膝下)动脉硬化性闭塞症治疗的可选手段。

ObjectiveTo evaluate the clinical effects of endovascular angioplasty and stenting for the treatment of TASC B, C arteriosclerotic occlusion（ASO） of lower extremity.MethodsAfter the identification of the occlusion by angiography via femoral artery access by Seldinger method, the occluded arteries （mean length 7.5cm; range 1~20 cm） in 40 patients（47limbs） were treated by percutaneous transluminal angioplasty and stent placement. ResultsThe primary recanalization was successful in 45 of 47 limbs. The technical successful rate was 96%. Thirty one self-expanding stents were deployed. PTA without stent placememt was performed in 16 limbs（of them, 11 were blow knee）.The ankle brachial pressure index （ABI） increased from （0.36±0.14） preoperatively to （0.82±0.15） on the 7th postoperative day. All patients were follow-uped for 1 to 48 months. Stents were occluded in 4 patients. Restenosis was observed in 1 limbs. All of the rest remained patent in the follow-up period.ConclusionEndovascular angioplasty and stenting can be an effective method for the treatment of long segmental （including below-knee） arteriosclerotic occlusion of lower extremities.