超声引导下血管成形术治疗DSA相对禁忌下肢动脉硬化闭塞症

Ultrasound-guided angioplasty in treatment of lower extremity arteriosclerosis obliterans in patients with relative contraindications for DSA

目的 探讨使用超声引导介入治疗DSA相对禁忌患者下肢动脉硬化闭塞症的临床价值。方法 对18例不宜接受DSA引导治疗的下肢动脉硬化闭塞症患者(共20条动脉)行超声引导下腔内治疗。于治疗前和治疗后24 h、3个月、6个月、12个月、24个月检测病变处收缩期血流峰值流速(PSV),并进行统计学分析,评估总复发率。结果 20支动脉中,完全闭塞15支,重度狭窄(狭窄率70%~99%)5支;超声引导下球囊扩张成形术成功率40.00%(8/20),支架植入术成功率100%(12/12)。术前与术后各时间点病变处PSV总体差异有统计学意义( F =4.26, P =0.046),术后各时间点与术前比较、术后12个月和24个月与术后24 h PSV差异均有统计学意义( P 均<0.05)。术后24 h、3个月、6个月、12个月、24个月的总复发率分别为0、5.00%(1/20)、10.00%(2/20)、20.00%(4/20)、50.00%(10/20)。结论 超声引导下肢动脉成形术治疗下肢动脉硬化闭塞症对介入治疗DSA相对禁忌患者有重要临床价值。

Objective To explore the clinical value of ultrasound-guided treatment of lower extremity arteriosclerosis obliterans (ASO) in patients with relative contraindications of DSA. Methods Eighteen not suitable for DSA patients with lower extremity ASO (evolving 20 arteries) were enrolled and treated with ultrasound-guided endovascular interventional therapy. Peak systolic velocity (PSV) was detected before and 24 hours, 3 months, 6 months, 12 months and 24 months after treatment. Statistical analysis was performed to evaluate the total recurrence rate of stenosis and occlusion of the arteries. Results Among 20 evolved lower extremity arteries, complete occlusion and severe stenosis (the stenosis rate ranged from 70% to 99%) were found in 15 and 5 arteries, respectively. The success rate of ultrasound-guided balloon angioplasty was 40.00%(8/20), while of stent placement was 100%(12/12). There was significant difference of PSV among preoperative and all postoperative time points ( F =4.26, P =0.046). Significant differences of PSV were observed between before operation and each time point after operation, 12 months and 24 months after operation compared with 24 hours after operation (all P <0.05 ). The total recurrence rate at 24 hours, 3 months, 6 months, 12 months and 24 months after operation was 0, 5.00%(1/20), 10.00%(2/20), 20.00%(4/20) and 50.00%(10/20), respectively. Conclusion Ultrasound-guided endovascular interventional therapy plays an important role for treatment of lower extremity ASO in patients with relative contraindications of DSA.