AngioJet血栓清除联合置管溶栓治疗下肢急性缺血

Application of AngioJet Thrombectomy Combined With Catheter-directed Thrombolysis in the Treatment of Acute Lower Limb Ischemia

目的探讨AngioJet血栓清除联合导管接触溶栓治疗下肢急性缺血的应用价值。方法回顾性分析2015年6月~2018年6月38例下肢急性缺血的临床资料,均行AngioJet血栓清除并结合尿激酶进行导管接触溶栓,如有残余狭窄,行球囊扩张及支架植入。结果38例腔内治疗的技术成功率为100%,其中13例溶栓后存在残余狭窄,采用球囊扩张及支架植入后狭窄解除。腔内治疗后血栓清除率>90%(Ⅲ级)27例,50%~90%(Ⅱ级)11例,术后即刻踝肱指数从0.36±0.11增至0.78±0.08(配对t检验,t=-20.050,P=0.000)。围手术期无并发症发生。保肢率为94.7%(36/38)。36例经临床及超声随访6~24个月,(15.1±5.6)月,患肢血流通畅,无血栓复发及截肢。结论AngioJet血栓清除联合尿激酶置管溶栓术可以快速、有效清除下肢动脉内血栓,安全性高,具有较好的临床应用价值。

Objective To investigate the value of AngioJet thrombectomy combined with catheter-directed thrombolysis in the treatment of acute lower limb schemia.Methods The data of 38 patients(38 limbs)with acute lower limb schemia from June 2015 to June 2018 were retrospectively analyzed.All the patients were treated with AngioJet thrombectomy combined with urokinase for catheter-directed thrombolysis after clinical diagnosis.Balloon dilatation and stent implantation were implemented if there was residual stenosis.Results The technical success rate of endovascular treatment in 38 patients was 100%.There were 13 cases of residual stenosis in the lower extremity arteries after thrombolysis,which were alleviated by balloon dilatation and stent implantation.After endovascular treatment,the thrombus clearance rate was more than 90%(Ⅲgrade)in 27 cases and 50%-90%(Ⅱgrade)in 11 cases.The ankle brachial index(ABI)was increased from 0.36±0.11 to 0.78±0.08 immediately after operation(paired t test,t=-20.050,P=0.000).No severe perioperative complications occurred.The limb salvage rate was 94.7%(36/38).After clinical and ultrasound follow-up for 6-24(15.1±5.6)months,36 patients had patent blood flow,without thrombus recurrence or amputation.Conclusion AngioJet thrombectomy combined with catheter-directed thrombolysis can quickly and effectively remove lower extremity arterial thrombosis,and it has high safety and good clinical application value.