单弯导管溶栓在单纯短段腘动脉闭塞病变腔内治疗中的应用

Catheter-directed thrombolysis with coude catheter in endovascular treatment of short segment occlusion of popliteal artery

目的:探讨单纯短段(10 cm以内)腘动脉闭塞治疗中应用单弯导管置管溶栓的可行性与疗效。方法:分析2012年2月—2016年2月行腔内治疗前置管溶栓处理的50例(55条肢体)单纯短段腘动脉闭塞患者资料,其中18例(21条腘动脉)应用单弯导管溶栓(单弯导管组),32例(34条腘动脉)应用常规溶栓导管溶栓(常规导管组),比较两组患者溶栓效率和并发症发生率。结果:两组中各有2条肢体溶栓无效,其余51条患肢症状明显缓解;单弯导管组平均溶栓长度明显大于常规导管组(38.3 mm vs.25.8 mm,P<0.05),平均ΔABI高于常规导管组(0.47 vs.0.32,P<0.05);单弯导管组和常规导管组出血并发症发生率分别为10.5%(2/19)、15.6%(5/32),差异无统计学意义(P>0.05)。结论:采用4 F单弯导管置管溶栓处理长度10 cm以内腘动脉短段闭塞病变,技术上可行,操作简单,溶栓效率较高,具有较高的临床实用价值。

Objective： To investigate feasibility and efficacy of catheter-directed thrombolysis （CDT） by using a coude catheter in the treatment of short segment occlusion （≤ 10 cm） of the popliteal artery. Methods： The clinical data of 50 patients （55 limbs） with short-segment occlusion of the popliteal artery undergoing CDT from February 2012 to February 2016 was analyzed. Of the patients, 18 cases （21 popliteal arteries） underwent CDT by using a coude catheter （coude catheter group） and 32 cases （34 popliteal arteries） received conventional CDT （conventional catheter group）. The thrombolysis efficiency and incidence of complications of the two groups were compared. Results： Thrombolysis failed in 2 limbs in each group, and the symptoms in the remaining 51 affected limbs were significantly improved. The average length of lesion removed by thrombolysis in coude catheter group was significantly greater than that in conventional catheter group （38.3 mm vs. 25.8 mm, P〈0.05）; the average AABI in coude catheter group was significantly higher than that in conventional catheter group （0.47 vs. 0.32, P〈0.05）. The incidence of hemorrhagic complications was 10.5% （2/19） and 15.6% （5/32） in coude catheter group and conventional catheter group respectively, which showed no significant difference （P〉0.05）. Conclusion： CDT with a coude catheter for no more than 10 cm short-segment occlusion of the popliteal artery is technically feasible and operationally simple with relatively high thrombolysis efficiency. It has certain application value in clinical practice.