关节部位闭合性动脉损伤的腔内修复治疗

Endovascular treatment for closed articular artery injuries

目的探讨关节部位闭合性动脉损伤腔内修复治疗临床可行性。方法回顾性分析解放军第一四八中心医院介入血管科2010年1月至2014年12月收治的13例关节部位闭合性动脉损伤行腔内修复患者临床资料。术中造影确定动脉损伤位置、程度及范围，测量损伤段动脉直径及长度。导管配合下将导丝送至损伤部位，建立“工作轨道”。若导丝难以贯通损伤段，则局麻下穿刺或解剖分离患侧远端动脉，经损伤动脉近、远段，采用导丝“抓捕”技术建立“工作轨道”。经健侧股动脉或患侧远端动脉置入合适尺寸支架。结果血管挫伤2例、部分断裂5例、完全断裂5例、动静脉瘘1例。共置入18枚支架，其中裸支架14枚，覆膜支架4枚。腔内修复均取得成功，无围手术期死亡及腔内修复手术相关并发症。随访15～48个月，平均（30±11）个月。3例患者支架腔内程度不同内膜增生，但狭窄率〈50％。随访期间未发现支架断裂、移位、变形等情况。结论关节部位闭合性动脉损伤腔内修复创伤小、手术时间短、术后恢复快。

Objective To explore the efficacy of endovascular treatment for closed articular artery injuries. Methods The clinical data of 13 patients from Jan 2010 to Dec 2014 treated for closed articular artery injuries were analyzed retrospectively. The location, severity and extent of arterial injury were confirmed by intraoperative arteriography. The diameter and length of the injured arteries were measured. The guidewire was sent to the lesion site and working wire pathway was established. When the guidewire was difficult to pass through tile lesion site, femoral and posterior tibial or radial artery may be used to establish working wire pathway. The stent or stent-graft was implanted through the contralateral femoral artery or distal end of ipsilateral artery. Results Intraoperative angiography confirmed intimal injury （ n = 2 ）, partial transection （ n = 5 ）, complete transection （ n = 5 ） and arteriovenous fistula （ n = 1 ）. Eighteen stents or stent-grafts were implanted. Treatment was successful in all patients without peiropeartive death and procedure-related complications. All were followed up for 15 to 48 months and the mean follow-up was （30 ±11 ） months. Three patients with stent lumen stenosis less than 50% as showed by angiography. There was no stent fracture, displacement, or deformation. Conclusions Endovascular treatment for closed articular artery injuries is of less invasion, shorter operative time and quick postoperative recovery.