多排螺旋CT在腘动脉陷迫综合征诊断中的应用

Diagnosis of Popliteal Artery Entrapment Syndrome with Multidetector Row Spiral Computed Tomography

目的总结多排螺旋CT在腘动脉陷迫综合征（PAES）诊断中的应用价值。方法回顾性分析2006年1月至2009年12月北京协和医院血管外科收治的经手术探查明确诊断PAES的10例患者共13条肢体的诊断与治疗。3例（30.0%）为双侧PAES。结果 11条肢体首诊时腘动脉已发生闭塞（84.6%）。体位变化检查、彩超和造影诊断PAES阳性率15.4%。螺旋CT诊断PAES的阳性率为100%。术中探查显示,Ⅰ型2例（15.4%）、Ⅱ型5例（38.5%）、Ⅲ型4例（30.8%）,Ⅴ型2例（15.4%）。单纯行腘动脉松解术2例,行腘动脉松解、血栓内膜剥脱、补片成型术8例,行置管溶栓、腘动脉松解术3例。随访时间4~33个月,中位随访时间22个月,1期通畅率92.3%（12/13）,累计通畅率100%（13/13）,救肢率100%。结论体位变化检查、彩超和动脉造影对已经闭塞的PAES诊断有一定局限性,螺旋CT对PAES的诊断和分型具有重要意义。

Objective To evaluate the role of multidetector row spiral computed tomography in the diagnosis of popliteal artery entrapment syndrome（PAES）.Method Ten patients（13 limbs） were diagnosed as PAES through open surgery in Peking Union Medical College Hospital from January 2006 to December 2009,among whom three（30.0%） had both limbs involved.Results Eleven limbs（84.6%） had occlusions in popliteal artery at admission.While only 15.4% of the patients were diagnosed as PAES by positional stress test,Doppler ultrasound,and arterial angiography,the disease was confirmed in all 10 patients by spiral computed tomography.As shown by inter-operative exploration,the PAES types included type Ⅰ（n=2,15.4%）,Ⅱ（n=5,38.5%）,Ⅲ（n=4,30.8%）,and Ⅴ（n=2,15.4%）.Two limbs underwent popliteal artery release only,8 limbs underwent politeal artery release,thromboendarterectomy,and angioplasty with a venous or prosthetic patch,and 3 patients underwent catheter-based thrombolysis and popliteal artery release subsequently.During the follow-up（mean： 22 months;range： 4-33 months）,the primary patency rate was 92.3%（12/13）,the total patency rate was 100%（13/13）,and the limb salvage rate was 100%.Conclusion Positional stress test,Doppler ultrasound,and arterial angiography play limited roles in the diagnosis of PAES with popliteal artery occlusion,while multidetector row spiral computed tomography is much helpful in diagnosing and typing PAES.