长段股浅动脉闭塞的内膜下成形术

Subintimal angioplasty of long superficial femoral artery occlusions

目的探讨内膜下成形术治疗长段股浅动脉闭塞的临床价值及中期随访结果。方法采用内膜下成形术(subintimal angioplasty,SIA)治疗32例临床表现为间歇性跛行和重症下肢缺血的长段股浅动脉闭塞患者,对初始通畅率、保肢率及其影响因素、并发症等进行分析。结果 32例SIA成功31例,技术成功率96.9%,31例成功再通者6、12、24、36个月的初始通畅率分别为96.8%、78.9%、58.8%和47.0%。跛行患者和重症下肢缺血患者的初始通畅率比较,差异无统计学意义(P>0.05)。膝下流出道血管数量和闭塞病变的长度对初始通畅率有影响(P<0.05,P<0.01)。32例中仅2例截肢,保肢率93.8%。出现并发症2例,其中1例动脉穿孔,经植入支架后未发生严重后果;另1例为假性动脉瘤形成,经超声引导下注射凝血酶后消失。结论 SIA是治疗长段股浅动脉闭塞的有效方法,中期随访效果满意。

Objective To evaluate the clinical value and mid-term follow-up results of subintimal angioplasty （SIA） in treatment of long superficial femoral artery occlusions.Methods SIA was performed in 32 patients with long superficial femoral artery occlusions having symptoms of intermittent claudication or critical limb ischemia.Primary patency rate,limb salvage rate,factors influencing long-term patency and complications were observed. Results Superficial femoral arteries of 31 patients acquired patency in operation of SIA,and the technical success rate was 96.9% （31/32）.In these 31 patients,the primary patency rates were 96.8%,78.9%,58.8% and 47.0% respectively at 6,12,24 and 36 months.There was no significant difference in primary patency between claudicant patients and patients with critical limb ischemia （P0.05）.The influence of quantity and quality of genicular inferior run off vessels and the length of the occlusion on primary patency were obvious （P0.01,P0.05 respectively）.Amputation was only performed in 2 patients,and the limb salvage rate was 93.8% （30/32）.Two cases suffered complications：1 case was artery perforation （no severe consequence occurred post implanting stent）; another case was formation of false aneurysm （disappearance post injecting thrombin guided by ultrasound）.Conclusions SIA is a effective procedure for recanalisation of long superficial femoral artery occlusions and the mid-term followed-up results are satisfying.