腘动脉穿刺逆行内膜下血管成形术治疗股浅动脉起始部长段硬化性闭塞疾病

Retrograde subintimal angioplasty via a popliteal artery approach for treatment of occlusive disease in initial ministerial segment of superficial femoral artery

目的：探讨经腘动脉逆行内膜下血管成形术（subintimal angiop lasty,SIA）治疗股浅动脉起始部长段闭塞疾病的临床效果和应用价值。方法：经腘动脉穿刺逆行SIA治疗股浅动脉起始部长段慢性硬化闭塞19例,采用PTA＋内支架（stent）置入。结果：全组治疗成功率100%（19/19）,无严重并发症发生;19例股浅动脉闭塞经腘动脉穿刺逆行SIA后,随访3~48个月,血流仍保持通畅为94.74%（18/19）,1例股浅动脉逆行SIA并支架置入12个月出现再阻塞,经局部溶栓,支架腔内血流均保持通畅。术前术后踝肱指数（ankle brachial index,ABI）平均0.25（0.12~0.43）和0.89（0.69~1.08）,两者比较差异有统计学意义（P〈0.05）。结论：经腘动脉逆行SIA是治疗股浅动脉起始部长段硬化闭塞,所致慢性严重肢体缺血的安全有效的方法。

Objective：To study the clinical effects and application value of retrograde subintimal angioplasty via a popliteal artery approach for treatment of occlusive disease in initial ministerial segment of superficial femoral artery.Methods：From May 2003 to August 2009,the above mentioned approach by PTA and endovascular stent implantation was performed in 19 patients with such a disorder.Results：The total achievement ratio was 100%（19/19）,no serious complications occurred;18（94.74%,18/19） superficial femoral arteries kept smooth bloodstream 3～48 months after the intervation and one superficial femoral artery was re-embolized 12 months afer stent implantation and revived smooth bloodstream by treatment with local thrombolysis.The average ankle brachial index（ankle brachial index,ABI） of preoperative and postoperative was 0.25（0.12～0.43） and 0.89（0.69～1.08）,respectively.ABI had significant difference between pre-operation and post-operation（P0.05）.Conclusion：Retrograde subintimal angioplasty via a popliteal artery is a safe and effective method for the treatment of chronic critical limb ischemia caused by this disease.