逆行穿刺路径下血管腔内治疗股腘动脉长段闭塞性病变

Endovascular treatment for long segment occlusion of femoral-popliteal artery by using retrograde puncture path

目的探讨逆行穿刺路径下血管腔内治疗股腘动脉长段闭塞性病变的临床应用价值。方法回顾性分析2009年6月至2017年1月收治的46例复杂股腘动脉长段闭塞性病变患者临床资料,其中男27例,女19例,平均年龄(69±8)岁;Rutherford分级3级32例,4级8例,5级6例;CTA显示病变平均长度(17±5)cm。结果 46例患者手术技术成功率为100%。小切口显露并穿刺动脉平均用时(5.2±2.3)min,7例使用4 F动脉鞘管,39例无鞘操作;41例导丝顺利通过股腘动脉闭塞段进入近端真腔,5例以顺逆行双向内膜下血管成形术(SAFARI)技术建立导丝工作轨道。术后第3日踝-肱指数(ABI)均值为(0.71±0.12),与术前(0.33±0.11)相比差异有显著统计学意义(t=12.483,P<0.001)。总体手术相关并发症发生率为23.9%(11/46),远端动脉穿刺并发症发生率为4.3%(2/46),围手术期无死亡患者。43例(93.5%)患者获随访3~24个月,术后3、6、12个月CTA复查支架一期通畅率分别为91.3%(4/46)、78.3%(10/46)、58.7%(19/46),1年保肢率为95.7%(44/46)。结论逆行穿刺路径下血管腔内治疗复杂股腘动脉长段闭塞性病变操作简单,安全有效,具有一定的临床应用价值。

Objective To assess the value of endovascular management in treating long segment occlusion of femoral-popliteal artery by using retrograde puncture path. Methods The clinical data of a total of 46 patients with long segment occlusion of femoral-popliteal artery, who were admitted to authors＇ hospital during the period from June 2009 to January 2017 to receive endovascular treatment, were retrospectively analyzed. The patients included 27 males and 19 females, with a mean age of （69＋8） years old. Grade Ⅲ of Rutherford classification was seen in 32 patients, grade IV in 8 patients, and grade V in 6 patients. On CT angiography, the mean length of occluded lesion was （17＋5） cm. Results In 46 patients of this series, the technical success rate was 100%. The average time used for making the small skin incision and puncturing the artery was （5.2±2.3） min. A 4-F artery sheath was employed in 7 patients, endovascular management with no use of artery sheath was carried out in 39 patients. The guide wire smoothly passed through the occluded segment of femoral-popliteal artery and entered the proximal true lumen in 41 patients. Subintimal arterial flossing with antegrade-retregrade intervention （SAFARI） technique was adopted to establish guide wire working track in 5 patients. On the third postoperative day, the ankle brachial index （ABI） was （0.71±0.12）, which was significantly different from preoperative （0.33±0.11 ）, and the difference was statistically significant （t=12.483, P〈0.001）. The overall incidence of operation-related complications was 23.9% （11/46）, the incidence of distal arterial puncture-related complications was 4.3%（2/46）. No death occurred in perioperative period. Forty-three patients （93.5%） were followed up for 3-24 months. CTA reexamination performed at 3, 6 and 12 months after treatment showed that the primary pateney rate of the stent were 91.3% （4/46）, 78.3% （10/46） and 58.7%（19/46） respectively, and the one-year limb salvage rate was 95.7%（44/46）. Conclusion For the treatment of long segment occlusion of femoral-popliteal artery, endovascular management by using retrograde puncture path is technically simple and clinically safe and effective, this technique has certain clinical application value.