经桡、股动脉序贯途径腔内治疗下肢动脉硬化闭塞症

Transradial-femoral Sequence Endovascular Therapy for Lower Extrementy Arterioscleroyic Occlusion

目的探讨经桡、股动脉序贯途径腔内治疗下肢动脉硬化闭塞症的可行性与疗效;与经股动脉、桡动脉途径比较,探讨最佳腔内治疗入路。方法回顾性分析我院2003年1月以来采用经不同途径腔内治疗的46例下肢动脉硬化闭塞的患者的临床资料。结果经股动脉途径治疗15例,平均溶栓时间为3天,3例穿刺口出血而终止治疗、4例由于无法忍受长时间制动而自动放弃治疗;行球囊扩张和或支架成形术有8例,6例术后患肢血流恢复。经桡动脉途径治疗有21例,溶栓时间平均长达10天,溶栓时间均较经股动脉途径要长;术后踝肱指数升高较经股动脉途径明显,但下肢血流恢复与经股动脉途径无显著差异。经桡、股动脉序贯途径治疗10例,术后平均踝肱指数大于1,下肢血流的恢复率达90%,均较其他两组显著提高。结论经经桡、股动脉序贯途径是腔内治疗下肢动脉硬化闭塞症最佳选择,下肢血流的恢复率高。

Objective To detect the feasibility and curative effect of transradial-femoral sequence endovascular therapy for lower extrementy arterioscleroyic occlusion,and the best endovascular approach through comparison with transradial and transfemoral approach.Methords Clinical data of 46 cases of lower extrementy arterioscleroyic occlusion treated with different endovascular approach from january 2003 were retrospectively analyzed.Results In all 15 cases treatment with transfemoral endovascular therapy（the average thrombolysis time were 3 days）,3 cases ended treatment for puncture side bleeding,4 cases gave up for intolerableness long time conf ining activity of lower limbs,8 cases performed transluminal angioplasty（PTA） and or endovascular stent,6 cases recovered blood flow of affected limb postoperation.Compared with transfemoral approach,of all 21 cases treatment with transradial approach,the average thrombolysis time were signif icantly prolonged（3 vs 10 days）,the ankle/brachial index（ABI） after treatment were signif icant higher,but the recovery rate of lower extrementy blood flow were no signif icant difference.Post performed with transradial femoral sequence endovascular therapy in 10 cases,ABI of postoperation exceeded one,and the recovery rate of lower extrementy blood flow were 90%.Compared with transradial and transfemoral approach,ABI of postoperation and recovery rate of lower extrementy blood flow were all signif icantly increased.Conclusion Transradial-femoral sequence approach for treatment lower extrementy arterioscleroyic occlusion is the best select with higher recovery rate of lower extrementy blood flow.