微球囊与长支架在下肢动脉硬化闭塞症介入治疗中的应用

Application of Micro-Balloon and Long Stent in the Interventional Therapy for Arteriosclerosis Obliterans of Lower Extremity

目的探讨微球囊与长支架在下肢动脉硬化闭塞症介入治疗中的应用价值。方法回顾性分析2009年3月至2011年11月行介入治疗的71例下肢动脉硬化闭塞症患者86条患肢的临床资料。按照2007年版跨大西洋多学科共识(TASCⅡ)分型,A型18条患肢,B型39条,C型20条,D型9条;临床FontaineⅠ期0条患肢,Ⅱ期35条,Ⅲ期45条,Ⅳ期6条。所有患者均接受血管腔内治疗,腘动脉及膝以下水平病变仅采用微球囊扩张成形术;股总动脉和股浅动脉病变球囊成形后根据血管情况可放置长支架。结果介入治疗技术成功率94.2%,81条患肢使用球囊及微球囊成功进行血管腔内成形术,其中58条患肢共置入66枚长支架,血液循环均得以重建和改善;5条动脉完全闭塞的患肢,未能完成血管再通。结论应用微球囊行膝关节及以下血管腔内成形术有较好的疗效;长支架可应用于股总动脉及股浅动脉长段慢性闭塞症治疗,但不宜跨关节放置。

Objective To evaluate the clinical value of micro balloon and long stent in the interventional therapy for ar- teriosclerosis obliterans of lower extremities. Methods The clinical data of 71 patients （86 limbs ） with arteriosclerosis obliterans of lower extremities from March 2009 to November 2011 were retrospectively studied. According to TASC （Trans Atlantic Inter-Society Consensus） published in 2007 ,there were 18,39,20 and 9 limbs conforming to type A, B, C and D respectively. In the light of Fontaine stages, the number of limbs in stage I ,Ⅱ,Ⅲand IV was 0, 35, 45 and 6. All the patients accepted iuterventional therapy. Micro balloon dilatation angioplasty was carried out in popliteal artery and infra- genual artery, and balloon dilatation angioplasty was performed in common femoral artery and superficial femoral artery,long stents were placed when necessary. Results The technical success rate of pereutaneous transluminal angioplasty was 94.2% （81/86）. 66 long-stent were placed in 58 limbs, the ischemic complaint was relieved obviously. The remaining 5 limbs with complete arterial occlusions failed to achieve revascularization. Conclusion The application of micro balloon obtain an ideal therapeutic effect in the ASO of infrapop liteal arterial. Long stents placement can be applied for the treat- ment of the long segment disease of ASO in the femoral artery and superficial femoral artery, but should not he placed across the joint.