双向入路治疗下肢动脉远端流出道闭塞性病变

The application of bidirectional approach technique in interventional treatment of occlusive lesion of distal outflow tract of lower extremity artery

目的探讨膝下动脉逆行穿刺建立双向入路治疗下肢动脉远端流出道闭塞性病变的技术特点、安全性和有效性。方法回顾性分析2018年1月至2019年3月47例患者临床资料,均为顺行入路开通血管失败的腘动脉和远端膝下动脉闭塞,中转采用远端动脉逆行穿刺建立双通路开通血管。结果技术总成功率为100%(47/47)。无死亡、截肢等严重并发症发生,穿刺并发症发生率为12.8%。术后6、12个月累计通畅率分别为70.5%(31/44)、43.2%(19/44)。结论在远端血管解剖条件允许下,双向入路治疗下肢动脉远端流出道闭塞性病变能提高血管开通率,并发症发生率低,近期保肢率高。

Objective To explore the technical characteristics,safety and effectiveness of retrograde puncture technique of infrapopliteal artery in establishing bidirectional approach for the treatment of occlusive lesion of distal outflow tract of lower extremity artery.Methods The clinical data of 47 patients with occlusion of popliteal artery and distal inferior geniculate artery,who received interventional treatment by using bidirectional approach technique to establish a pathway to open blood vessels after anterograde approach to open blood vessel failed during the period from January 2018 to March 2019 at authors’hospital,were retrospectively analyzed.Results The overall technical success rate was 100%(47/47).No severe complications,including death,amputations,etc.,occurred.The incidence of puncture-related complications was 12.8%.The 6-month and 12-month cumulative patency rates were 70.5%(31/44)and 43.2%(19/44)respectively.Conclusion When the anatomical conditions of the distal vessels are permitted,interventional treatment with bidirectional approach technique for occlusive lesion of distal outflow tract of lower extremity artery can improve the recanalization rate of vessels with less complications and higher short-term limb salvage rate.(J Intervent Radiol,2020,29:707-710)