准分子激光斑块消蚀术治疗下肢动脉慢性闭塞

Treatment of chronic total occlusion of lower limb artery with excimer laser atherectomy

目的分析准分子激光斑块消蚀术(excimer laser atherectomy,ELA)治疗下肢股浅动脉以及膝下动脉慢性闭塞病变的安全性和可行性.方法我们率先在华南地区采用ELA治疗下肢动脉慢性闭塞所致严重肢体缺血(critical limb ischemia,CLI)2例,1例为股浅动脉原发闭塞性病变,采用ELA联合紫杉醇涂层球囊处理;1例为胫后动脉原发闭塞病变,采用ELA联合普通球囊扩张处理.结果2例患者手术顺利,术后前向血流通畅,下肢缺血明显改善,无需补救性植入支架,无手术并发症.术后1个月跛行距离延长,足部溃疡愈合,复查超声显示股浅动脉及胫后动脉血流通畅.结论ELA治疗下肢股浅及膝下动脉慢性闭塞病变安全可行.

Objectives To analyze the safety and feasibility of excimer laser atherectomy(ELA)for the treatment of lower extremity femoral artery and chronic occlusion of lower knee artery.Methods Two cases of critical limb ischemia(CLI)caused by chronic total occlusion of lower extremity artery were treated with ELA.One case with superficial femoral artery occlusion,and a combination of ELA combined with paclitaxel eluting balloon was used.One case was posterior tibial artery occlusion,treated with ELA combined with plain balloon dilatation.Results Both of the two procedure was successful with good blood flow.After one month follow-up,lower limb claudication was significantly improved and the foot ulcer was healed.No bail-out stent or further amputation was needed.The superficial artery and the posterior tibial artery were patent with good blood flow checked by echo.Conclusions ELA is safe and feasible to treat lower limb artery with chronic total occlusion lesion.