目的 探讨腔内支架置入治疗泛大西洋协作组(TransAtlantic Inter-Society Consensus,TASC)ⅡC、D级股动脉病变的可行性及近期疗效.方法 2008年1月～2010年12月,对24例患者(共27条股动脉,C级21条,D级6条)进行腔内治疗,开通成功后应用球囊扩张闭塞段并置入自膨式支架.结果 成功开通25条股动脉,开通率92.6％( 25/27),2条股动脉因病程较长、病变段钙化严重未能开通而行开放外科旁路术.25条股动脉共置入支架62枚.6条患肢的间歇性跛行距离由术前的61 m(30～150 m)增加至术后7天的560 m(300～950 m)(t=3.54,P=0.018).12条患肢的疼痛消失,5条患肢疼痛可忍受,2条患肢疼痛偶尔需口服止痛药物缓解.所有患肢皮肤颜色变红润,腘动脉、足背和(或)胫后动脉搏动明确.踝肱指数由术前0.36±0.12增至术后7天的0.78 ±0.25(t =2.16,P=0.038).19例(21条股动脉)随访4～ 25个月(平均9.8月):4例各有1条股动脉分别于术后7、11、12和15个月时出现支架内狭窄及血栓形成,其中3例经导管溶栓和球囊扩张后症状缓解,另1例行股腘动脉旁路术后症状缓解,其余15例(17条患肢)均无缺血症状加重表现.结论 腔内支架治疗TASCⅡC、D级股动脉病变具有安全和微创的优点,短期效果良好.%Objective To evaluate the feasibility and short-term efficacy of endovaacular stenting for TASC II grades C/D femoral artery occlusions. Methods Since January 2008 to December 2010, 24 patients with femoral artery occlusion (27 femoral arteries, grade C in 21 and grade D in the other 6) underwent endovascular interventions in our hospital. After recanalization and balloon dilation, we placed self-expanding stent into the deceased vessel. Results In the 27 occluded arteries, 25 femoral arteries were successfully recanalized (recanalization rate: 92.6% ) ; the other 2 arteries were converted to an open bypass surgery for severe calcification after a long disease course. Totally 62 stents were implanted in the 25 recanalized femoral arteries. After the procedure, claudication distance in 6 limbs increased from preoperative 61 m (30 -150 m) to 560 m (300 -950 m) 7 days postoperation (t = 3. 54, P = 0.018). Rest pain was vanished in 12 limb, improved in 5 limbs, and improved with occasional analgesia in 2 limbs. All the diseased limbs had the skin turned rosy, and the pulse of the dorsalis pedis and posterior tibial arteries palpable. The ankle-brachial indices ( ABIs) increased from pre-procedure 0. 36 ± 0. 12 to 7-day post-procedure 0. 78 ± 0. 25 ( t = 2. 16, P = 0. 038 ). Follow-up was achieved in 19 cases (21 arteries) for 4 to 25 months with a mean of 9. 8 months. During the follow-up, 4 femoral arteries (4 patients) developed in-stent stenosis and thrombosis at 7th, 11th, 12th and 15th month, respectively; 3 of them were cured with catheter-directed thrombolysis and percutaneous transluminal angioplasty ( PTA) , and the other was improved with femoro-popliteal bypass. The other 15 patients (17 affected extremities) showed no severe ischemic symptoms during the follow-up. Conclusion Endovascular stenting is safe and minimally invasive for TASC Ⅱ grades C/D femoral artery occlusions with an optimistic short-term outcome.
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