多节段下肢动脉硬化闭塞症介入治疗及手术治疗体会

Interventional and open surgical treatment of multi - segmental arteriosclerosis obliterans in lower extremity

目的 总结一侧髂动脉闭塞合并下肢动脉长段闭塞患者治疗的临床效果.方法 对于一侧髂动脉同时合并下肢动脉长段闭塞的多节段下肢动脉硬化闭塞症患者,间歇跛行距离小于50m或有静息痛者采用髂动脉支架或联合血管旁路术治疗下肢动脉硬化闭塞症32例.结果 行髂动脉病变段球囊扩张及内置支架术29例36枚支架,3例髂动脉介入治疗失败,行股浅动脉病变段支架置入3例,行股-腘动脉膝上血管旁路术13例,行膝下血管旁路术2例,3例髂动脉支架治疗失败者2例行股-股动脉耻骨上旁路术,1例放弃治疗.介入治疗及手术治疗均取得成功.随访3～36个月,3例患者因肿瘤或急性心肌梗塞死亡,大部分患者临床症状消失.1例股浅动脉支架1个月后闭塞,后因肢体严重缺血截肢.3例股-腘旁路血管闭塞,1例接受取栓手术好转,1例截肢,1例无静息痛间歇跛行距离大于50m应用药物治疗.结论 支架置入或联合血管旁路术是治疗多节段下肢动脉硬化闭塞症的安全有效方法 .

Objective To explore the efficacy of interventionat and open surgical treatment for multi - segmental arteriosclerosis obliterans （ASO） in lower extremity. Methods A total of 32 patients with multi - segmental ASO were enrolled in the study. These patients developed iliac ASO complicated by unilateral long segment of ASO in lower extremity. They presented with claudication less than 50 meters and/or rest pain. Treatments included iliac stenting alone or in combination with artificial graft bypass operation. Results A total of 29 patients underwent percutaneous transluminal angioplasty （ PTA ） on iliac artery with 36 stent placements. The interventional treatment of iliac artery failed in 3 patients. Among them,2 underwent femoral -femoral artery bypass operation above the pubic bone and 1 gave up the treatment. Stents were placed in 3 cases of superficial femoral artery obliterans. Thirteen patients underwent femoral - popliteal arterial bypass operation above the knee and 2 patients were given the bypass procedure below the knee. The clinical symptoms were relieved and rest pain disappeared in most patients during the follow up of 3 to 36 months. Three patients died of cancer or myocardial infarction. One stent in the superfi- cial femoral artery was occluded 1 month after the treatment, which leaded to amputation because of critical limb ischemia lately. Three femoral - popliteal bypasses were closed. Among them,one benefited from em- bolectomy, one patient received amputation and 1 patient was under medical treatment, showing pain - free walking more than 50 meters and no rest pain. Conclusion Stent placement and/or in combination with artificial graft bypass operation are safe and effective for the treatment of lower extremity arteriosclerotic diseases.