经腘动脉入路逆行内膜下血管成形术治疗股浅动脉长段硬化性闭塞症

Retrograde Subintimal Angioplasty via Popliteal Artery Access for Treatment of Long Occlusive Disease of Superficial Femoral Artery

目的探讨经腘动脉入路逆行内膜下血管成形术治疗股浅动脉长段硬化性闭塞症的可行性和近期效果。方法回顾性分析17例因股浅动脉/腘动脉近端完全闭塞接受经腘动脉入路逆行内膜下血管成形术/支架置入术患者的资料,总结技术成功率和近期临床疗效,分析术中术后并发症发生情况及防治方法。结果腘动脉穿刺成功率和手术即时成功率为100%。踝臂指数(ABI)从术前的0.43±0.23上升至0.89±0.26(P<0.01)(出院前),6个月(0.86±0.25)及12个月(0.81±0.23)(P<0.01)时保持改善状态。术后6个月的初次通畅率为94.7%(16/17);12个月时初次通畅率为76.5%(13/17),再次通畅率为100%。并发症(3例,17.6%)主要有腘动脉穿刺点假性动脉瘤、股动脉穿刺点出血及肢体远端动脉急性栓塞,根据情况给予了相应处理。结论对于长段股浅动脉/腘动脉近端闭塞性病变,在腔内顺行开通失败的情况下运用经腘动脉入路逆行内膜下血管成形术/支架置入术是一种安全有效的补救措施。

Aim To study the feasibility and short term efficacy of retrograde subintimal angioplasty via popliteal artery access for treatment of long occlusive disease of superficial femoral artery. Methods 17 patients were performed with retrograde subintimal angioplasty and endovascular stent implantation via popliteal artery access for treatment of long occlusive disease of superficial femoral artery （SFA） and proximal popliteal arteries （PA）. Procedural success rate and short-term clinical efficacy were summarized. The complications together with the therapy and preventions were also ana- lyzed. Results The success rate of popliteal artery puncture was 100%. All operations were finished successfully. The mean ankle brachial index increased from 0. 43 ± 0. 23 to 0. 89 ± 0. 26 （ P 〈 0. 01 ） at discharge and remained im- proved at 6 （0.86±0.25） and 12 months （0.81±0.23）（P〈0.01）. Primary patency were94.7%（16/17）, 76.5% （13/17） at 6 months and 12 months respectively. Secondary patency was 100% at 12 months. Three （ 17. 6% ） major complications occurred, including pseudoaneurysm of PA, bleeding at the femoral puncture site and acute embolism of dis- tal limb artery. Conclusion Failed antegrade attempts to recanalize long occlusive disease of the SFA and proximal PA can be salvaged using a retrograde popliteal access for subintimal angioplasty and endovascular stent implantation, with a low complication rate.