血管腔内介入联合外科手术治疗下肢多节段动脉硬化闭塞症

Intervention therapy combined with bypass operation for multilevel atherosclerotic occlusive disease

目的:探讨下肢多节段动脉硬化闭塞症(arteriosc lerosis ob literans,ASO)的治疗手段及临床疗效。方法:采用髂动脉球囊扩张、支架植入结合动脉旁路术治疗下肢多节段ASO 19例。行髂动脉病变段球囊扩张及内置支架术19例,股→腘动脉膝上人工血管旁路移植12例和自体大隐静脉旁路移植4例,左股→右股动脉人工血管耻骨上旁路移植3例。结果:手术均获得成功,未出现严重并发症。术后踝肱指数(0.73±0.17),较术前(0.23±0.12)明显提高(P<0.01)。平均随访18个月,与术前相比症状明显好转,行走距离加大(>1 000 m),2例残余间歇性跛行。结论:下肢动脉腔内介入结合动脉旁路术是治疗下肢多节段ASO的有效方法。

Objective：To explore an effective procedure for multilevel atherosclerotic occlusive disease.Methods：Iliac angioplasty and stenting combined with femoro-popliteal bypass were performed on 19 patients with lower extremity multilevel atherosclerotic occlusive disease.Iliac angioplasty and stent procedures were applied to 19 cases,femoro-popliteal bypass with artificial vessels to 12 cases,femoro-popliteal bypass by great saphenous vein to 4 cases and femoro-femoral bypass to 3 cases.Results：The operation was successful in all the cases and no wound-related complications occurred.The mean postoperative ankle-brachial index（0.73±0.17） was much better than the preoperative index（0.23±0.12）（P0.01）.The followup time was 18 months on the average;the clinical symptoms in all the cases improved obviously,only 2 cases remained intermittent claudication.Conclusions：Intracavity intervention therapy combined with bypass operation is effective for treatment of lower extremity multilevel atherosclerotic occlusive disease.