介入联合手术治疗长段髂动脉闭塞病变

Intervention Combined with Surgical Treatments for Long-segment Iliac Artery Occlusion

目的探讨介入联合手术治疗长段髂动脉闭塞病变的近期治疗效果。方法回顾性分析2008年8月～2010年6月介入联合手术治疗11例(13条)长段髂动脉闭塞的临床资料。双侧髂动脉合并腹主动脉下段闭塞2例(4条),髂动脉合并股总动脉闭塞6例,髂动脉合并多发股浅或腘动脉闭塞3例。对11例(13条)长段髂动脉闭塞病变行Fogarty球囊取栓联合球囊扩张成形支架植入,并进行门诊和电话随访。结果 13条髂股动脉均开通成功,下肢缺血症状出现或加重2个月内的7条患肢术中取出较多血栓。术后未出现伤口感染、血肿、肺炎、死亡,术后1周踝肱比(ABI)由术前的0.07±0.13提高至0.56±0.19,差异有显著性(t=8.517,P=0.000)。随访12～28个月,平均18个月,13条患肢均保存良好,髂动脉一期通畅。结论介入联合手术治疗长段髂动脉闭塞病变的近期效果良好,并发症发生率较低。介入联合手术治疗在患肢缺血症状突然出现或加重2个月内的髂动脉长段闭塞病变,以及髂动脉闭塞合并股总动脉闭塞病变的患者具有较大优势。

Objective To investigate the short-term efficacy of interventional combined surgical treatments for long-segment iliac artery occlusion. Methods A retrospective analysis was rhade on 11 patients （13 limbs） with long-segment iliac artery occlusion, who underwent interventional combined surgical treatments in our hospital from August 2008 to June 2010. Among the cases, 2 patients （4 limbs） had bilateral iliac artery occlusion complicated with lower aortic occlusion, 6 patients showed occlusion in of the iliae artery and common femoral artery, and the other 3 patients had iliac artery occlusion combined multiple occlusions in the superficial femoral artery or popliteal artery. Fogarty catheter thrombectomy combined with balloon angioplasty was performed on all the patients. Follow-up at outpatient department or by phone call was carried out afterwards. Results The iliac artery was recanalized successfully in all the patients. In seven cases, who showed ischemia symptoms in the lower limbs or had the symptoms aggravated for two months, several thrombi were removed. No incisional infection, hematoma, pneumonia, or death occurred after the procedure. The ABI was increased significantly from 0.07 ＋ 0.13 to 0.56 ~ 0.19 in one week postoperation （t = 8. 517 ,P = 0. 000）. The patients were followed up for 12 to 28 months with a mean of 18 month, during which all the affected limbs were preserved well with patent iliac artery. Conclusions Interventiona] therapy combined with surgical treatment is effective in short term for long-segment iliac artery occlusion, with a low rate of complications. The procedure especially suits the patients who suddenly appeared or had aggravated ischemia symptoms or those who had iliae artery combined with common femoral artery occlusions.