下肢血栓闭塞性脉管炎影像学分型及疗效分析

The radiographic classification and therapeutic effect of lower extremities thromboangiitis obliterans

目的初步探讨下肢血栓闭塞性脉管炎的影像学分型及临床意义。方法回顾性分析新疆维吾尔自治区人民医院血管外科2006年1月至2014年1月下肢血栓闭塞性脉管炎84例患者影像及临床资料。结果 84例患者影像资料示下肢血栓闭塞性脉管炎分为髂股型(15例)、股腘型(4例)、膝下型(28例)。54例行血管重建术分别为13例行自体大隐静脉搭桥术、4例行球囊血管扩张联合支架置入术、14例行球囊扩张联合置管溶栓术、23例动脉切开取栓术联合干细胞移植术。围手术期2例行膝上截肢术,3例行膝下截肢术,11例行截趾术。随访时间3~40个月,平均(16±12)个月。总体手术成功率70.4%,术后6个月通畅率50%(24/48),12个月通畅率64.6%(31/48)。结论对于有良好远端流出道的患者,首选自体大隐静脉搭桥术,无良好远端流出道的患者可选择球囊扩张术,疗效尚可。对于慢性患者急性血栓形成的患者动脉切开取栓联合干细胞移植是一种可行、有效的方法。

Objective To discuss imaging types and clinical significance of the lower extremities thromboangiitis obliterans(TAO). Methods Between January 2006 and January 2014, the imaging and clinical data of 84 cases of TAO was reviewed retrospectively. And 54 cases were underwent revascularization.According to imaging data, TAO was classified into 3 types: ilio-femoral type, femoral-popliteal type and below-knee type. Of 54 cases including 13 cases of autogenous great saphenous vein bypass,4 case of balloon dilation combined with stent implantation, 14 cases of balloon dilation combined with catheter-directed thrombolysis and 23 cases of embolectomy by arteriotomy and hematopoietic stem cell transplantation, 38 cases received operation successfully(70.4%). During the follow-up time, above-knee amputation, belowknee amputation and toe amputation was performed on 2,3 and 11 cases, respectively. The mean follow-up time was 16±12 months(range, 3~40 months). Patency rate 6 months after operation was 50%(24 / 48),patency rate 12 months after operation was 64.6%(31 / 48). Conclusion Autogenous great saphenous vein bypass surgery should be choose firstly if distal outflow is good. Balloon dilation is acceptable if distal outflow is poor. In chronic patients with acute thrombosis, embolectomy by arteriotomy and hematopoietic stem cell transplantation is an effective and feasible treatment.