导管直接溶栓联合动脉成形术治疗慢性股浅动脉闭塞症

Combination of catheter directed thrombolysis and artery angioplasty for the treatment of chronic long superficial femoral artery occlusion

目的 评价动脉内导管直接溶栓结合下肢动脉成形术治疗慢性股浅动脉闭塞的效果.方法 回顾性分析2010年9月至2012年9月期间我院对慢性股浅动脉闭塞性病变进行介入治疗的患者的临床资料,其中先行动脉导管溶栓、随后行球囊成形或球囊成形加支架置入术19例;直接行球囊成形支架置入术组37例.结果 溶栓组溶栓前后重度狭窄和闭塞段血管长度为[（16±5） mm,（10±6） mm,t =3.598,P＜0.05）],溶栓后病变血管长度明显减少.溶栓组和支架组置入支架长度及个数比较[（10±5） cm,（12±4） cm,t=2.062,P＜0.05;（1.6±0.8）个,（2.1±0.7）个,t=2.102,P＜0.05）].先行溶栓组和直接行支架置入组6、12、24个月一期通畅率、一期辅助通畅率、二期通畅率,差异无统计学意义.结论 对于慢性股浅动脉闭塞的患者,采用动脉导管溶栓＋球囊成形支架置入术,可以缩短病变血管长度、从而减少置入支架的数量.

Objective To evaluate intra-arterial catheter directed thrombolysis in combination with artery angioplasty for chronic long superficial femoral artery occlusion.Methods Clinical data were reviewed on patients of chronic long superficial femoral artery occlusion treated by endovascular therapy from September 2010 to September 2012.In 19 patients,catheter-directed thrombolysis was initially carried out,which was followed by endovascular angioplasty balloon dilatation or stent placement.The other 37 patients were treated by upfront endovascular angioplasty balloon dilatation or stent placement.Results In the thrombolysis group,the occluded length of the artery before and after thrombolysis was （16 ± 5） mm and （10 ± 6） mm（t =3.598,P ＜ 0.05）.The length and the number of stents used in thrombolysis group was lower than stent group [（10±5） cm、（1.6±0.8） vs.（12±4） cm、（2.1 ±0.7）,t=2.102,P＜0.05].There were no significant difference in primary patency rate assisted,primary patency rate and secondary patency rate between thrombolysis group and stent group.Conclusions For patients of chronic long superficial femoral artery occlusion,a successful catheter directed thrombolysis with artery angioplasty reduces the number of stents for angioplasty.