双腔导管取栓治疗慢性下肢动脉栓塞疗效分析

Analysis of clinical effect of embolectomy with double-lumen catheter in the treatment of chronic lower extremity artery embolism

目的总结利用双腔Fogarty导管取栓治疗慢性下肢动脉栓塞的经验。方法收集本院2010年1月至2014年12月间利用双腔球囊导管取栓结合其他腔内技术治疗的慢性下肢动脉栓塞患者资料,回顾性分析其发病特点、影像学表现、治疗方法选择以及治疗效果。结果共治疗慢性下肢动脉栓塞31例,均以患肢静息痛或间歇性跛行就诊,平均病程25.2（7-64）天。患者均接受双腔Fogarty导管取栓及术中溶栓,同时施行置管溶栓4例,经皮腔内血管成形术6例,植入支架3例。取栓成功93.5%,膝下两条以上通畅流出道比率87.1%。术后患肢平均踝肱指数（ABI）水平明显提高（0.81±0.031vs 0.33±0.030,P〈0.001）,90.3%患者术后Rutherford分级提高2级以上,截肢率3.2%。平均随访23.6个月,栓塞动脉通畅率96.6%。1例（3.4%）复发而再次切开取栓获得成功。无围手术期死亡、大出血、骨筋膜室综合征及永久性肾功能衰竭等并发症。结论双腔Fogarty导管取栓是慢性下肢动脉栓塞快速、有效的治疗手段。

Objective To summarize the experience of embolectomy with double-lumen Fogarty catheter in the treatment of chronic lower extremity artery embolism. Methods The data of patients who were diagnosed with chronic lower extremity artery embolism and were treated with double-lumen catheter as well as other endovascular treatment in our hospital from January 2010 to December 2014 were collected.Characteristics, imaging features, treatment protocols and clinical effect were analyzed retrospectively.Results Thirty-one patients were recruited. Rest pain or severe claudication was the chief complaint and the average time from symptom presentation to admission was 25.2 days（7 to 64 days）. All the patients received embolectomy via femoral artery access using double-lumen Fogarty catheter and intra-operative thrombolysis. Sequent catheter-directed thrombolysis,percutaneous transluminal angioplasty and bare stent implantation were conducted in 4（12.9%）,6（19.4%） and 3 patients（9.7%）, respectively. The success rate of embolectomy was 90.3%. Blood flow in more than 2 below-the-knee arteries was restored in 27patients（87.1%）. Average value of ankle brachial index（ABI） was improved obviously after operation（0.81±0.031 vs 0.33 ±0.030, P 〈0.001）.Rutherford classification increased two levels after operation in 93.5%patients. The major amputation rate was 3.2%. During the follow-up time of 23.6 months in average, patency rate of the involved artery was 96.6%, and one patient underwent re-embolectomy successfully because of recurrence. No death, hemorrhage, osteofascial compartment syndrome or permanent renal failure occurred.Conclusion Embolectomy with, double-lumen Fogarty catheter is safe and efficient in the treatment of chronic lower extremity artery embolism.