下肢动脉硬化闭塞症减容治疗术中并发症及其处理

Management of complications during volume reduction therapy for peripheral arterial disease of lower extremities

目的分析下肢动脉硬化闭塞症减容治疗术中并发症及其处理。方法回顾性分析167例接受减容治疗的下肢动脉硬化闭塞症患者(188肢),按照不同减容治疗方式分为溶栓组(43例46肢,接受置管溶栓术)、取栓组(42例49肢,接受机械血栓清除术)及旋切组(82例93肢,接受定向斑块旋切术)。分析各组术中并发症的种类、发生率、处理方式及治疗有效性。结果对溶栓组46条患肢均行置管溶栓术。取栓组中,16肢采用Angiojet取栓导管治疗,33肢采用Rotarex取栓导管治疗。旋切组中,21肢采用Silverhawk斑块旋切系统治疗,72肢采用Turbohawk斑块旋切系统治疗。减容治疗技术成功率为98.94%(186/188)。溶栓组、取栓组、旋切组并发症发生率分别为28.26%(13/46)、6.12%(3/49)及6.45%(6/93)。术中并发症包括血管破裂出血14例、栓子脱落引发栓塞5例、急性血栓形成2例及导丝断裂1例(1条患肢),分别给予压迫止血、覆膜支架植入、栓子抽吸、置管溶栓及断裂导丝抓捕处理,未出现治疗相关死亡者。3组间血管破裂出血发生率差异有统计学意义(P=0.002)。术后全部患者Rutherford分级较术前明显改善(Z=2.730,P=0.002)。结论减容治疗下肢动脉硬化闭塞症效果确切。血管破裂出血是术中最常见的并发症,且于置管溶栓术后并发症发生率最高;及时干预有利于避免造成严重后果。

Objective To investigate the management of complications during volume reduction therapy for peripheral arterial disease of lower extremities.Methods Data of 167 patients (188 limbs) with lower extremity peripheral arterial disease who underwent volume reduction therapy were retrospectively analyzed.According to methods of volume reduction treatment,the patients were divided into thrombolysis (43 cases,46 limbs),thrombectomy (42 cases,49 limbs) and directional atherectomy (82 cases,93 limbs) groups.The kinds,incidence and symptomatic treatment of complications in each group,and the efficacy of the treatments were analyzed.Results A total of 46 limbs were treated with catheter direct thrombolysis in thrombolysis group.In thrombectomy group,16 limbs underwent thrombectomy with Angiojet catheter and 33 limbs underwent thrombectomy with Rotarex catheter.In directional atherectomy group,21 limbs underwent atherectomy with Silverhawk system and 72 limbs underwent atherectomy with Turbohawk system.The total technical success rate of volume reduction therapy was 98.93%(186/188).The incidence of operative complications was 28.26%(13/46),6.12%(3/49) and 6.45%(6/93) in group of thrombolysis,thrombectomy and directional atherectomy,respectively.Surgical complications included 14 cases (14 limbs) of vascular rupture and bleeding,5 cases (5 limbs) of embolism caused by embolus,2 cases (2 limbs) of acute thrombosis and 1 case (1 limb) of guide wire rupture,all were resolved after symptomatic treatments including compression,balloon attachment,covered stent implantation or thrombolysis.There was no operative related death.Statistical difference only existed in the incidences of bleeding among three groups ( P =0.002).After the volume reduction treatments,Rutherford classification of the patients were significantly improved (Z=2.730,P =0.002).Conclusion The effectiveness of volume reduction treatments are definite.Bleeding is the commonest complication,which is highest in patients underwent catheter direct thrombolysis.Timely treatments are helpful to avoid adverse events caused by operation-related complications of volume reduction therapy.