导丝会师技术在腋动脉损伤腔内治疗中的临床应用

Guide-wire“meeting”technique in the treatment of acute traumatic axillary artery injuries by interventional therapy

目的探讨导丝会师技术在腋动脉损伤腔内治疗中的应用价值。方法回顾性分析2008年1月—2020年8月解放军第九六〇医院收治的腋动脉损伤患者22例,男性16例,女性6例;年龄30~66岁,平均40.3岁。经股动脉及患侧桡动脉入路,双向入路导丝会师腋动脉损伤段,经股动脉引入圈套器,将导丝拉出体外,建立股-桡动脉的“体外导丝”工作轨道,然后行支架植入术。观察患者围术期情况、治疗效果、手术并发症及再干预情况等。结果腔内治疗过程中采用导丝会师技术成功率100%,共植入支架34枚,平均1.5枚,术中造影示腋动脉血流完全恢复通畅。随访6~49个月,平均28.6个月,支架内血流通畅或支架腔内狭窄小于30%未行腔内干预20例,支架腔内狭窄超过50%再次腔内治疗2例,无支架移位、断裂、内瘘等。结论腋动脉损伤腔内治疗过程中采用导丝会师技术成功率高,术后并发症少,临床效果满意,应用价值大。

Objective To explore the value of guide-wire“meeting”technique in the treatment of traumat-ic axillary artery injuries by interventional therapy.Methods A retrospective analysis was made on the medical re-cords of 22 cases of traumatic axillary artery injury treated at No.960 Hospital of PLA by interventional therapy from Jan.2008 to Aug.2020,including 16 males and 6 females,with an average of 40.3 years(range,30-66 years).Through the femoral and affected radial arteries,the bidirectional approach guide-wire accessed the injured segment of the axillary artery,a goose neck snare was introduced through the femoral artery,which was pulled out of the body to establish a femoral-radial artery passage,followed by stent implantation.The perioperative conditions,therapeutic effects,surgical complications and re-intervention were recorded.Results The guide-wire“meeting”technique achieved a 100%success rate in the 22 cases,with 34 stents deployed,mean 1.5 stents.Intraoperative angiography revealed that the blood flow of the traumatic axillary artery was fully restored.All the 22 cases were followed up for 6-49(mean 28.6)months.Among them,20 cases showed stent patency or<30%stent lumen stenosis;2 cases had>50%stent lumen stenosis and received re-intervention.During the follow-up period,no displacement,fracture or leakage of the stent was reported.Conclusion Guide-wire“meeting”technique in the treatment of traumatic axillary artery injuries has a high intraoperative success rate,few complications and good outcomes,which is worthy of application.