下肢动脉栓塞症的腔内治疗

Endovascular interventional therapy of lower extremity arterial embolism

目的探讨腔内介入治疗下肢动脉栓塞（10wer extremity arteries embolism，LEAE）的方法、疗效及安全性。方法回顾性分析29例LEAE患者的临床及影像资料。结果29例均经导管抽吸出血栓。其中股、胴、胫前动脉及胫腓干栓塞分别为23、2、3、1例。单纯导管抽栓治疗17例，导管抽栓＋尿激酶溶栓治疗9例，导管抽栓＋球囊扩张治疗2例，导管抽栓＋支架治疗1例。29例患者均顺利开通栓塞动脉，但9例抽栓后破碎的小栓子脱落栓塞远端血管或远端血管血栓形成，采用抽栓联合尿激酶溶栓治疗后，4例完全开通栓塞的远端血管，3例部分开通栓塞远端血管，2例溶栓后远端血管仍不能开通，但侧支循环较前明显增多。随访（18±4）个月，23例患者下肢缺血症状完全消失，5例患者栓塞侧足部皮温降低、肤色苍白、末梢血运差，1例截肢治疗。结论腔内介入治疗下肢动脉栓塞具有微创、安全的特点，在行造影的同时，可进行腔内介入治疗，可降低患肢缺血、坏死的发生率。

Objective To investigate the efficacy and safety of endovascular interventional treatment of lower extremity arterial embolism （LEAE）. Methods A retrospective analysis on clinical and imaging data was made on 29 LEAE cases. Results In those 29 cases the diagnosis of LEAE was confirmed and embolus extracted by catheter suction. The femoral artery, popliteal artery, anterior tibial artery and tibiofibular bole embolism were in 23, 2, 3, 1 cases respectively. Catheter suction, catheter suction plus thrombolysis, catheter suction plus balloon dilatation, and catheter suction plus stenting treatment were carried out in 17, 9, 2, 1 cases respectively. In all these 29 cases the artery was successfully reopened. In the 9 cases whose distal vessels were embolized by small emboli or thrombosis after initial catheter suction treated by remedy suction and plasminokinase management, artery was completely opened in 4 cases, partially opened in 3 cases, still closed in 2 cases with increased collateral shunts. During follow-up of （18± 4 ） m, lower extremity ischemic symptoms completely disappeared in 23 cases, low skin temperature, pale skin, poor peripheral blood flow were reported in 5 cases, and 1 case had to receive amputation. Conclusions Endovascular interventional treatment is a minimally invasive and safe treatment for LEAE.