AngioJet机械抽栓在糖尿病下肢动脉硬化闭塞症支架植入术后再闭塞的临床应用

Clinical application of AngioJet mechanical thrombectomy for in-stent restenosis after stent treatment in diabetes mellitus with arteriosclerosis obliterans

目的探讨AngioJet机械抽栓在糖尿病合并下肢动脉硬化闭塞症(ASO)支架植入术后再闭塞的临床应用价值。方法回顾性分析2017年5月至2020年5月云南省第二人民医院血管外科收治的30例(30条肢体)糖尿病合并ASO行股浅动脉支架植入术后再闭塞患者的临床资料。经下肢动脉CTA明确诊断后行AngioJet机械抽栓,根据病变程度辅以球囊扩张术,术中即刻造影评价血管通畅情况,术后采用ABI、足趾血氧饱和度(SaO_(2))、足部皮温、穿刺点并发症及血红蛋白尿等指标观察疗效。结果本组全部病例下肢血流恢复通畅,术后ABI、足趾SaO_(2)、足部皮温均较术前升高,差异有统计学意义(P均<0.05)。穿刺点血肿发生率为3.33%(1/30),血红蛋白尿发生率为83.33%(25/30)。本组30例患者均获得随访,随访时间为(18.8±8.6)个月,其中8例(26.67%,8/30)再次出现支架内闭塞,经再次AngioJet机械抽栓辅以球囊扩张后,血流恢复通畅。结论AngioJet机械抽栓可以快速、有效、安全地清除支架内血栓,具有良好的临床疗效。

Objective To investigate the value of AngioJet mechanical thrombectomy for in-stent restenosis after stent treatment in diabetes mellitus with arteriosclerosis obliterans(ASO).Methods The clinical data of 30 patients(30 limbs)of diabetes mellitus with ASO,who developed superficial femoral artery in-stent occlusion after stent implantation from May 2017 to May 2020,were retrospectively analyzed.The diagnosis was confirmed by CT angiography(CTA)and AngioJet mechanical thrombectomy was carried out in all patients.According to the degree of lesions,balloon dilatation was performed.Intraoperative angiography was used to evaluate the patency of blood vessels immediately.ABI,toe SaO_(2),foot skin temperature,puncture site complications and hemoglobinuria were used to observe the postoperative efficacy.Results Blood flow was unobstructed in all cases.The clinical indexes of postoperative ABI,toe SaO_(2),foot skin temperature were higher than those of preoperative(all P<0.05).The incidence of hematoma at puncture site was 3.33%(1/30).The incidence of hemoglobinuria was 83.33%(25/30).All of the 30 patients were followed up for(18.8±8.6)months.The stent occlusion reoccurred in 8 cases(26.67%,8/30).The blood flow was recovered,after AngioJet mechanical thrombectomy assisted with balloon dilatation.Conclusion AngioJet mechanical thrombectomy can quickly,effectively and safely remove the thrombus in the stent with good clinical efficacy.