腔内支架治疗泛大西洋协作组(TASC)Ⅱ C、D级股动脉病变

Endovascular Stenting for TASC Ⅱ Grades C/D Femoral Artery Occlusion

目的探讨腔内支架置入治疗泛大西洋协作组(TransAtlantic Inter-Society Consensus,TASC)ⅡC、D级股动脉病变的可行性及近期疗效。方法 2008年1月～2010年12月,对24例患者(共27条股动脉,C级21条,D级6条)进行腔内治疗,开通成功后应用球囊扩张闭塞段并置入自膨式支架。结果成功开通25条股动脉,开通率92.6%(25/27),2条股动脉因病程较长、病变段钙化严重未能开通而行开放外科旁路术。25条股动脉共置入支架62枚。6条患肢的间歇性跛行距离由术前的61 m(30～150 m)增加至术后7天的560 m(300～950 m)(t=3.54,P=0.018)。12条患肢的疼痛消失,5条患肢疼痛可忍受,2条患肢疼痛偶尔需口服止痛药物缓解。所有患肢皮肤颜色变红润,腘动脉、足背和(或)胫后动脉搏动明确。踝肱指数由术前0.36±0.12增至术后7天的0.78±0.25(t=2.16,P=0.038)。19例(21条股动脉)随访4～25个月(平均9.8月):4例各有1条股动脉分别于术后7、11、12和15个月时出现支架内狭窄及血栓形成,其中3例经导管溶栓和球囊扩张后症状缓解,另1例行股腘动脉旁路术后症状缓解,其余15例(17条患肢)均无缺血症状加重表现。结论腔内支架治疗TASCⅡC、D级股动脉病变具有安全和微创的优点,短期效果良好。

Objective To evaluate the feasibility and short-term efficacy of endovascular stenting for TASCⅡ grades C/D femoral artery occlusions.Methods Since January 2008 to December 2010,24 patients with femoral artery occlusion（27 femoral arteries,grade C in 21 and grade D in the other 6） underwent endovascular interventions in our hospital.After recanalization and balloon dilation,we placed self-expanding stent into the deceased vessel.Results In the 27 occluded arteries,25 femoral arteries were successfully recanalized（recanalization rate： 92.6%）;the other 2 arteries were converted to an open bypass surgery for severe calcification after a long disease course.Totally 62 stents were implanted in the 25 recanalized femoral arteries.After the procedure,claudication distance in 6 limbs increased from preoperative 61 m（30-150 m） to 560 m（300-950 m） 7 days postoperation（t=3.54,P=0.018）.Rest pain was vanished in 12 limb,improved in 5 limbs,and improved with occasional analgesia in 2 limbs.All the diseased limbs had the skin turned rosy,and the pulse of the dorsalis pedis and posterior tibial arteries palpable.The ankle-brachial indices（ABIs） increased from pre-procedure 0.36±0.12 to 7-day post-procedure 0.78±0.25（t=2.16,P=0.038）.Follow-up was achieved in 19 cases（21 arteries） for 4 to 25 months with a mean of 9.8 months.During the follow-up,4 femoral arteries（4 patients） developed in-stent stenosis and thrombosis at 7th,11th,12th and 15th month,respectively;3 of them were cured with catheter-directed thrombolysis and percutaneous transluminal angioplasty（PTA）,and the other was improved with femoro-popliteal bypass.The other 15 patients（17 affected extremities） showed no severe ischemic symptoms during the follow-up.Conclusion Endovascular stenting is safe and minimally invasive for TASCⅡ grades C/D femoral artery occlusions with an optimistic short-term outcome.