X线导向下逆行腘动脉穿刺植入支架治疗股浅动脉闭塞症九例

Under X-ray guidance stent implantation through retrograde popliteal artery puncturing for the treatment of superficial femoral artery occlusion:the initial results in nine cases

目的探讨X线导向下逆行腘动脉穿刺在股浅动脉闭塞介入治疗中的应用价值。方法对9例股浅动脉长段闭塞患者采用经股动脉入路顺行开通受阻,改用X线导向下逆行腘动脉穿刺技术成功建立通路后,对闭塞段行球囊扩张及支架植入治疗。结果 9例患者腘动脉穿刺技术均获成功,闭塞段股动脉均获开通,间歇性跛行症状消失,未出现相邻神经、血管损伤等严重并发症。踝肱指数由术前0.38±0.13升至术后0.92±0.11,差异有统计学意义(P<0.01)。随访2～16个月,1例患者于术后11个月间歇性跛行复发,CTA示股动脉支架下端狭窄,再次行经皮腔内血管成形术后好转。结论 X线导向下经腘动脉入路治疗股浅动脉闭塞成功率高、安全性好,在股动脉顺行开通受阻时,是有效的治疗下肢动脉硬化闭塞的选择途径。

Objective To discuss the application of retrograde popliteal artery puncturing under X-ray guidance in the interventional therapy for superficial femoral artery occlusion.Methods Retrograde popliteal artery puncturing under X-ray guidance was carried out in nine patients with long-segment occlusion of superficial femoral artery as antegrade recanalization via femoral artery approach had failed in them.After retrograde route was successfully established,the balloon dilation and subsequent stent placement for occluded vessel were performed.Results The technical success was obtained in all patients.The occluded superficial femoral arteries were reopened and the symptoms of intermittent claudication disappeared.No serious complications such as injuries of adjacent nerves or vessels occurred.The ankle-brachial index（ABI） increased from preoperative（0.38 ± 0.13） to postoperative（0.92 ± 0.11） with the difference being statistically significant（P 0.01）.A follow-up period lasting for 2-16 months was conducted.Eleven months after the treatment,intermittent claudication recurred in one case,and CT angiography showed that the distal part of the stent was narrowed.The symptoms were improved after percutaneous transcatheter angioplasty was performed again.Conclusion Retrograde popliteal artery puncturing under X-ray guidance is an effective and safe technique for the treatment of superficial femoral artery long-segment occlusion with stent placement,especially for patients in whom antegrade recanalization via femoral artery approach fails.