膝下动脉逆穿技术在下肢动脉硬化闭塞症中的应用

Application of below-the-knee arteries antegrade retrograde interventionin the treatment ofarterial occlusive diseases of lower extremity

目的评估介入治疗顺行入路失败时逆穿膝下动脉治疗下肢动脉硬化闭塞症的安全性及有效性。方法选择2018年1月-2019年6月本院收治的共25例逆穿膝下动脉的下肢动脉硬化闭塞症患者作为研究对象,记录分析靶血管穿刺成功率、靶病变技术成功率、并发症发生率、术前术后患肢ABI数值。结果25例患者中,22例靶血管穿刺成功,穿刺成功率88%(22/25)。22例穿刺成功患者中,19例导丝通过靶病变后实现技术成功,技术成功率86%(19/22)。术后超声评估膝下动脉穿刺点无出血、血肿、夹层及假性动脉瘤等,并发症发生率0%(0/22);19例逆穿技术成功患者术后ABI(0.66±0.10)较术前ABI(0.35±0.14)明显提高,差异有统计学意义(P<0.05)。结论下肢动脉硬化闭塞症患者顺行操作失败时,膝下动脉逆穿是一种安全、有效的补救措施。

Objective To investigate the efficacy and safety of below-the-knee arteries retrograde interventionin the treatment of arterial occlusive diseases of lower extremity after thefailure of conventional antegrade approach.Methods 25 patients were treated with below-the-knee retrograde access from 2018-01 to 2019-06 after the failure of antegrade approach.The success rate of target vessel puncture,technical success rate,complication rate,ABI before and after the procedure were recorded and analysed.Results 22 of 25 patients got successful puncture and the success rate of target vessel puncture was 88%(22/25).19 of 22 patients who were punctured successfully achieved technical success,the technical success rate was 86%(19/22).No access bleeding,hematoma,vessel dissection and pseudoaneurysm were found with the ultrasound assessment after procedure,the complication rate was 0%(0/22).The postoperative and preoperative ABI of the 19 patients who were achived technical success were 0.66±0.10 and 0.35±0.14 respectively,the differences were statistically significant(t=13.12,P<0.001).Conclusions Below-the-knee retrograde access is a highly safe and reliable remedial option when antegrade recanalization fails.