置管溶栓在下肢动脉支架内血栓形成治疗中的应用

Application of catheter-directed thrombolysis for the treatment of stent thrombosis of lower extremity artery

目的探讨置管溶栓在下肢动脉支架内血栓形成(stent thrombosis,ST)治疗中的有效性和安全性。方法回顾性分析2010年1月至2015年12月于重庆医科大学附属第一医院血管外科诊断为下肢动脉ST且采用留置侧孔溶栓导管行溶栓治疗的14例患者的临床资料,评估置管溶栓对下肢动脉ST的治疗效果及其相关并发症。结果 14例患者技术操作全部成功,11例溶栓成功,再通率为78.57%,1例溶栓治疗中缺血症状加重改行Fogarty导管取栓术后再通,2例溶栓治疗中缺血症状继续加重行截肢术。其中1例出现穿刺点渗血,1例出现穿刺点血肿。平均随访10个月,患肢动脉无再狭窄发生。结论置管溶栓是治疗下肢动脉ST的一种创伤小、并发症发生率低、血栓溶解血管再通率高的治疗方法。

Objective To discuss the efficacy and safety of catheter-directed thrombolysis in treating tent thrombosis of lower extremity artery.Methods During the period from January 2010 to December 2015,14 patients were diagnosed with stent thrombosis of lower extremity artery,and received catheter-directed thrombolysis.The clinical data were retrospectively analyzed.The efficacy and related complications were evaluated.Results All of the technical operations have been successful.Successful thrombolysis were in 11 cases,and the recanalization rate was 78.57%.Fogarty catheter embolectomy under DSA monitoring had to be carried out in one patient as he failed to respond catheter-directed thrombolysis.2 patients underwent amputation as a result of irreversible limb necrosis.The complications happened in 2 cases were directly related to the catheter-directed thrombolysis,which included one case of hematoma at puncture site and one case of bleeding at puncture site.All patients were followed up for a mean period of 14 months,and no re-stenosis occurred.Conclusion Catheter-directed thrombolysis is a minimally invasive method in treating stent thrombosis of lower extremity artery,which has a low incidence of complications and a high rate of thrombolysis.