真腔内技术治疗股腘动脉硬化闭塞症55例

True lumen technique arteriosclerosis obliterans in the application of endovascular treatment for femoropopliteal of the lower extremities

目的总结真腔内通过闭塞段技术治疗下肢股胭动脉硬化闭塞症的临床疗效。方法2009年3月至2013年3月苏州大学附属第二医院对55例患者共60条股胭动脉硬化闭塞肢体行真腔内技术腔内治疗，术前平均闭塞血管长度（13±3）cm，平均踝肱指数（ABI）为0．47±0．06。术中在路径图下单弯导管与导丝配合，采用“捻转”导丝技术真腔内通过闭塞段，并行病变段血管球囊扩张内置支架或斑块旋切治疗。结果本组技术成功率为91．7％；9例行球囊扩张术（percutaneoustransluminalangioplasty，PTA），41例行PTA＋stent，5例行斑块旋切术；平均支架使用数目（1．6±0．6）枚，平均支架长度为（8．2±1．4）cm。术后第3天ABI平均0．73±0．10，与术前相比，差异有统计学意义（P〈0．01）。出现并发症者13例，1例截肢；成功随访46例患者48条肢体，随访时间为（24±11）个月；术后6、12、24个月的平均ABl分别为0．72±0．15、0．67±0．13和0．63±0．19。术后12、24个月支架的一期、辅助、二期通畅率分别为73．0％、81．1％、89．2％和63．6％、68．2％、72．7％。结论应用真腔内技术治疗股胭动脉硬化闭塞有较高的成功率，并可获得良好的近期疗效，减少应用支架总长度。

Objective To evaluate the clinical effect of the application of true lumen technology in endovascular treatment of femoropopliteal arteriosclerosis obliterans of the lower extremity. Methods From April 2009 to April 2013, 60 limbs in 55 patients of femoropopliteal arteriosclerosis obliterans received endovaseular treatment using the true lumen technique. The average length of occlusion artery before operation was（ 13 ±3）cm, and the average ABI（ ankle braehial index）was 0. 47 ± 0. 06. With the help of Roadmap, the vertical artery catheter and small diameter guide wire were usually applied during the operation,and we used the ＂rotation＂ technique to make sure guide wire goes through the occlusive segment in the true lumen. After the accomplishment of the guide wire, we performed angioplasty and atherectomy. Patients were followed up regularly by ultrasound or CTA. Results The technical success rate was 91.7%. We performed PTA in 9 cases, PTA and stent placement in 41 cases and 5 cases received endovascular atherectomy. The average number of stent placed during operation was 1.6 ± 0. 6 and average length of stent was（8.2 ± 1.4）cm. The average ABI 3 days after operation was 0. 73 ±0. 10 （P 〈0. 01 ）. 13 cases developed complications and amputation was done in 1 case. 48 legs in 46 patients were followed up for the average period of （24 ± 11 ） months. The average ABI of 6 months, 12 months and 24 months after operation were 0. 72 ±0. 15, 0. 67 ±0. 13 and 0. 63 ±0. 19 respectively. The primary patency rate, assistant patency rate and secondary patency rate in 12 months and 24 months were 73.0% , 81.1% , 89. 2% and 63.6% , 68.2% , 72.7% respectively. Conclusions The high successful rate and satisfactory early result could be obtained through the application of true lumen technology in the endovascular treatment of femoropopliteal atherosclerosis obliterans.