穿刺点反向调头同治双下肢动脉硬化闭塞症9例

Simultaneous treatment of bilateral lower extremity arteriosclerotic occlusive diseases by making a reverse U-turn of catheter at puncture point:initial experience in 9 cases

目的探讨穿刺点反向调头术在同时治疗双下肢动脉硬化闭塞症(ASO)中的可行性、临床价值及技术要点。方法回顾性分析2013年3月至2015年3月云南省第三人民医院成功实施穿刺点反向调头术治疗的9例患者临床资料。选择血管造影明确为双侧腹股沟下多发节段动脉狭窄/闭塞需要双侧治疗、治疗中耗材相同患者,在X线导引下作穿刺点反向调头术。结果拟行穿刺点反向调头术10例中9例治疗成功,穿刺右侧股动脉6例,左侧3例。治疗股浅动脉和腘动脉共10支均成功,治疗胫前动脉、胫后动脉、腓动脉共25支,19支成功。术后随访期9例患者下肢供血明显改善,症状消失或明显减轻。未发生调头术相关并发症。结论穿刺点反向调头术是一较安全、方便治疗双下肢ASO的方法,使一点穿刺治疗范围扩大,还可节省医疗费用。

Objective To discuss the feasibility, clinical application and technical points of reverse U- turn catheterization at puncture point in simultaneously treating bilateral lower extremity arteriosclerotic occlusive diseases. Methods The clinical data of 9 patients, who successfully received interventional treatment with reverse U-turn catheterization technique at the Third People＇s Hospital of Yunnan Province during the period from March 2013 to March 2015, were retrospectively analyzed. Bilateral below-inguinal multiple segmental artery stenoses and/or occlusions were confirmed by selective angiography, which was followed by sinmltaneous treatment of bilateral lower extremity arteriosclerotic occlusive diseases with the technique of reverse U-turn catheterization at puncture point. Results Of the 10 patients, successful treatment with the technique of reverse U-turn catheterization at puncture point was accomplished in 9; right femoral artery was punctured in 6 patients and left femoral artery was punctured in 3 patients. All 10 diseased superficial femoral arteries and popliteal arteries were successfully treated, while only 19 of 25 diseased anterior tlbial arteries, posterior tibial arteries and peroneal arteries were successfully treated. During the follow-up period, in the 9 patients the lower limb blood supply was significantly improved and the clinical symptoms disappeared or were significantly relieved. No U-turn catheterization-related complications occurred. Conclusion For simultaneous treatment of bilateral lower extremity arteriosclerotic occlusive diseases, the use of reverse U-turn catheterization technique is safe and convenient. The use of one puncture point will be able to expand the extent of treatment, and save medical costs as well.