下肢动脉硬化闭塞症治疗后再闭塞的处理

Management of recurrent occlusion of lower limb arterial occlusions

目的总结下肢动脉硬化闭塞症治疗后再闭塞的治疗经验。方法网顾性分析2007年1月至2011年12月70例患者的临床资料，其中30例单纯股一胭动脉旁路术、15例单纯腔内成形术、25例联合治疗后下肢单侧动脉再次闭塞。70例患者共发生98次动脉闭塞。10例次在发生末次闭塞时保守治疗（组），余88例次行手术治疗[包括单纯股或人工血管取栓15例次（单纯取栓组），取栓＋局部动脉微导管置入（组）抗凝溶栓13例次，取栓＋远端动脉成形＋微导管置入抗凝溶栓60例次]。结果保守治疗组膝上截肢5例，失访2例。单纯取栓组膝上、下截肢各1例，失访2例。取栓＋微导管置入组膝下截肢1例，死亡2例。取栓＋动脉成形＋微导管置入组急性肾衰转透析后失访1例。本组63例患者获得随访，随访时间8～60个月，平均（24±5）个月。其中44例血管通畅，通畅率69．8％。8例患者血管闭塞后截肢，总截肢率为12．7％。结论对于动脉硬化闭塞症治疗后再闭塞的患者，取栓＋腔内血管成形＋微导管置入局部抗凝溶栓近期效果较好。

Objective To explore the experience in the treatment of postoperative reocclusion in patients of lower limb arterial occlusion. Methods From January 2007 to December 2011, clinical data were reviewed on 98 reocclusion episodes in 70 patients, who had been treated by graft bypass （30 patients）, or angioplasty （15 patients） or both （25 patients）. In this series, 10 eases received conservative treatment and to the other 88 episodes reoperation was given, including thrombectomy alone in 15 episodes, and thrombectomy combined with microcatheter application for 13 episodes, and thrombectomy combined with angioplasty and microcatheter application for 60 episodes. Results Two patients died during follow-up period and 5 patients were lost to follow-up including 2 receiving conservative treatment. The other 63 patients were followed-up for 8 to 60 months, averaging （24 ± 5 ） months. The arterial pateney in patients receiving reoperation treatment was 69. 8% （44 patients ） and the amputation rate was 12.7% （8 patients）. Conclusions For postoperative recurrent arterial occlusion in patients of lower limb arterial occlusion, thrombectomy combined with angioplasty and mierocatheter application may generate satisfactory results.