目的 探讨内膜下血管成形术(SIA)治疗长段股浅动脉闭塞的临床价值及中期随访结果.方法 采用SIA治疗45例临床表现为间歇性跛行和重症下肢缺血的长段股浅动脉闭塞患者,对中远期通畅率、保肢率及其影响因素进行统计学分析.结果 45例中,SIA成功治疗43例,其中36例经股浅动脉顺行成功再通,技术成功率为80.0%,另7例经同侧腘动脉入路逆行开通,总技术成功率为95.6%.43例成功再通者6、12、24、36个月的初始通畅率分别为85.7%、69.0%、57.3%和50.9%.跛行患者和重症下肢缺血患者间的初始通畅率差异无统计学意义(P ＞ 0.05).膝下流出道血管数量和闭塞病变的长度是影响初始通畅率主要因素(P ＜ 0.05).结论 SIA是治疗长段股浅动脉闭塞的有效方法之一,中期随访效果满意.%Objective To discuss the clinical value of subintimal angioplasty in treating long segment occlusion of superficial femoral artery and to observe its midterm results. Methods Subintimal angioplasty was performed in 45 patients with long segment occlusion of superficial femoral artery, whose clinical presentation was intermittent claudication or critical limb ischemia. The primary patency , limb salvage and factors influencing long-term patency were observed. and the clinical data were analyzed. Results Of the total 45 cases. the subintimal angioplasty was successfully accomplished in 43. The success rate of antegrade approach technique via the superficial femoral artery was 80％ (n = 36), the occlusion was recanalized by using retrograde approach technique via ipsilateral popiteal artery in 7 case. The total technical success rate was 95.6％. The primary patency in 43 successful cases at 6, 12, 24 and 36 months was 85.7％, 69.0％,57.3％ and 50.9％, respectively. No statistically significant difference in primary patency existed between the group of intermittent claudication and the group of critical limb ischemia (P ＞ 0.05). Statistically significant prediction factors for primary patency included the number of the run off vessels below the knee and the length of the occ:lusion (P ＜ 0.05). Conclusion Subintimal angioplasty is an effective procedure for the treatment of long segment occlusions of superficial femoral arterv with satisfactory mid-term results. (J Intervent Radiol, 2011, 20 : 773-777)
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