支架成形联合置管溶栓治疗TASC(Ⅱ)D型主髂动脉闭塞性疾病

摘要

Objective To investigate the feasibility, safety and efficacy of endovascular stenting angioplasty combined with catheter - directed thrombolytic therapy in treating TASC-D type aorto-iliac artery occlusive diseases, and to discuss the feasibility of endovascular angioplasty for iliac - femoral artery and deep femoral artery. Methods A total of 8 patients with TASC-D type aorto-iliac artery occlusion were enrolled in this study. Three patients suffered from occlusion of aorto-common iliac - external iliac arteries (n = 3), the aortic occlusive length was 2 - 6 cm. One patient had severe stricture of distal abdominal aorta complicated by right common iliac and external iliac artery occlusion. The other four patients had bilateral or unilateral common iliac and external iliac artery occlusion. Four cases had long segment obstruction of superficial femoral artery. Percutaneous angioplasty together with endovascular stenting was carried out in all patients. Postoperative supplementary indwelling catheter thrombolysis was employed in five patients. The results were analyzed. Results Technical success and clinical improvement were obtained in all patients. Preoperative ankle - brachial index (ABI) was 0.58, and postoperative ABI was 0.76. One patient developed small area infarction in left cerebellum with no serious sequelae. All patients were followed up for a mean period of 14 months, and no re - stenosis occurred. Conclusion For chronic extensive aorto - iliac occlusive diseases, endovascular angioplasty is a safe and effective treatment, and satisfactory clinical efficacy as well as short-term to mid-term patency of the artery can be reliably obtained. Catheter-directed thrombolysis following stent implantation can effectively prevent the occurrence of thrombosis. Endovascular angioplasty of iliac - femoral and deep femoral arteries can improve the symptoms of the affected limb.%目的 探讨TASC(Ⅱ)D型主髂动脉闭塞性疾病血管内成形术辅助置管溶栓治疗的可行性、安全性及疗效,并对髂-股/股深动脉血管内成形术的可行性作一探索.方法 8例主髂动脉闭塞患者病变均为TASC(Ⅱ)D型,其中3例主动脉-髂总动脉-髂外动脉闭塞,主动脉闭塞长度为2～6cm,1例腹主动脉远端重度狭窄伴右侧髂总动脉、髂外动脉闭塞,另外4例为双侧或单侧髂总动脉及髂外动脉闭塞.其中4例伴有股浅动脉长段闭塞.所有患者均采用PTA+内支架治疗,5例于血管内成形术后行辅助置管溶栓治疗.结果 8例患者主髂动脉闭塞段病变均成功开通；4例伴股浅动脉长段闭塞患者仅行主/髂-股/股深动脉内支架成形术,而股浅动脉病变未予处理.技术均获成功,症状均获缓解,踝臂指数术前为0.58,术后为0.76.1例于术后出现左侧小脑小面积梗死,未发生严重后遗症.平均随访时间14个月,无再狭窄发生.结论 慢性广泛主髂动脉闭塞病变,血管腔内成形术是一项安全有效的治疗措施,可获得较满意的临床疗效及近中期通畅率；支架植入后留置导管溶栓可以有效防止血栓形成的发生；髂-股深动脉血管内成形术可以达到改善患肢症状的治疗目的.