血管内超声在下肢动脉腔内治疗中的应用分析

Application Value of Intravascular Ultrasound in Lower Limb Artery Endovascular Treatment

目的:探讨血管内超声(IVUS)在下肢动脉闭塞病变患者腔内血管重建术中的应用价值。方法:回顾性分析2019年7月至2020年7月于中南大学湘雅二医院血管外科接受IVUS和数字减影血管造影(DSA)指导下腔内技术治疗的24例下肢动脉闭塞病变患者术前、术中情况和术后随访数据,比较IVUS和DSA对血管准备后残余狭窄和夹层程度的判断结果,对比患者术前和术后的跛行距离和治疗侧肢体踝臂指数,分析患者的生存率、治疗侧肢体血管通畅率和严重并发症发生情况。结果:24例患者中,男性19例(79.2%),女性5例(20.8%);平均年龄为(64.7±13.6)岁;23例(95.8%)病因为动脉硬化闭塞症,1例(4.2%)为血栓闭塞性脉管炎;共治疗24条肢体,技术成功率为95.8%。所有患者在下肢动脉腔内治疗中均成功进行IVUS检查。术中使用IVUS和DSA判断血管准备后的残余狭窄程度[面积百分比vs.直径百分比:(79.6±13.3)%vs(47.6±27.8)%]和夹层程度分级[(4±1)级vs(.3±1)级]差异均有统计学意义(P均<0.05)。平均随访(8.0±4.5)个月,患者生存率为100%,无截肢事件发生,治疗侧下肢动脉通畅率为91.7%。结论:IVUS辅助下肢动脉腔内治疗具有较好的安全性和效果,对于发现血管准备后病变残余狭窄和夹层形成的可能比DSA更敏感。IVUS作为下肢动脉腔内治疗的辅助影像学工具的必要性和有效性仍需更多临床研究结果的支持。

Objectives:To explore the application value of intravascular ultrasound(IVUS)in lower limb artery endovascular treatment(EVT).Methods:We retrospectively analyzed 24 cases of IVUS and digital subtract angiography(DSA)assisted lower limb artery EVT during July 2019-July 2020.Analysis items includes clinical data before operation,during operation,and during follow-up,IVUS/DSA image data were also analyzed.The identification results by IVUS and DSA on residual stenosis and dissection,as well as claudication distance and ABI before and after operation were compared.Survival,vessel patency and related complications were analyzed.Results:There were 19 males(79.2%)and the mean age was(64.7±13.6)years old in this cohort.The etiology is atherosclerosis occlusion in 23 patients(95.8%),and thrombosis obliterans in 1 patient(4.2%).The technique success rate was 95.8%.IVUS examination was successful during EVT in all 24 patients.IVUS played an important role in helping the decision making of the treatment strategy.Extent of judged residual stenosis([79.6±13.3]%vs.[47.6±27.8]%)and dissection degree([4±1]degree vs.[3±1]degree)after vascular preparation by IVUS and DSA differed significantly(both P<0.05).The mean follow-up duration was(8.0±4.5)months.All patients survived,there was no amputation event,the primary vessel patency rate was 91.7%during follow up.Conclusions:IVUS application is safe and effective in lower limb EVT.It is superior to regular DSA on checking residual stenosis degree and dissection degree after vascular preparation compared.Future clinical research is needed to validate the effectivity and feasibility of IVUS,as an assisted imaging tool,in lower limb EVT.