流变血栓清除术在治疗外周动脉闭塞性疾病中的应用

Clinical application of rheolytic thrombectomy in treating the occlusions of peripheral arteries

目的 评价流变血栓清除术治疗外周动脉闭塞性疾病的临床疗效与安全性。方法 对2 0例阻塞时间在 90d内的外周动脉闭塞患者 ,其中闭塞段位于肱动脉 1例 ,髂动脉 2例 ,髂股动脉2例 ,股浅动脉 9例 ,股动脉 1例 ,动脉 2例 ,胫后动脉 2例 ,腓动脉 1例 ,闭塞长度 4～ 2 1cm ,平均(12 1± 4 8)cm ,采用经皮穿刺方法置入 6F或 7F 2种型号Hydrolyser流变溶栓导管并与高压注射器相接 ,将生理盐水以 4ml/s的注射流率和 5 171kPa的压力注入行流变血栓清除术治疗 ,观察血管再通、临床疗效和并发症发生情况。结果 流变血栓清除术后 ,19例 (95 % )重建了前向血流并清除了大部分血栓物质 ,技术成功率 (残留狭窄 <5 0 % )为 85 % (17/ 2 0 ) ;12例附加经皮经腔血管成形术 (PTA)、3例附加内支架治疗 ;18例 (90 % )临床症状有不同程度改善 ,无改善者 2例 ,其中 1例截肢。 2 4h及30、90d的初始血管开放率分别为 95 %、80 %和 70 %。与流变血栓清除术相关的并发症有远端栓塞1例 ,血管破裂 1例。结论 流变血栓清除术能迅速、安全有效地清除急性或亚急性血栓。

Objective To evaluate the efficacy and safety of hydrodynamic rheolytic thrombectomy catheter (Hydrolyser) for treatment of occlusions of peripheral arteries. Methods In 20 patients with occlusions of peripheral arteries, rheolytic thrombectomy was performed with the Hydrolyser. Mean occlusion time was( 49.1±18 )days and mean thrombus length was (12.1±4.8) cm. The revascularization, clinical efficacy, and complications were observed. Results After rheolytic thrombectomy, the majority of thrombus material was removed and antegrade blood flow was reestablished in 19 (95%) patients. Technical successful rate (residual luminal narrowing < 50%) was 85% (17/20). Adjunctive therapy was performed in 15 patients. Clinical improvement after intervention was +3 in 7 (35%) patients, +2 in 9 (45%) patients, +1 in 2 (10%) patients, and 0 ( no improvement) in 2 (10%) patients. One above the knee amputation was performed 7 days after thrombectomy. Complications related to use of Hydrolyser were distal embolization in one (5%) and dissection in one (5%). Primary patency rates were 95% after 24 hour, 80% after 30 days, and 70% after 3 months. Conclusion The hydrodynamic rheolytic thrombectomy catheter appears to be safe and effective for rapid thrombectomy of acute or subacute thrombus.