经腘动脉入路逆行治疗同侧股浅动脉近端狭窄和闭塞的临床应用

摘要

目的 探讨经腘动脉入路逆行治疗同侧股浅动脉近端狭窄和闭塞的临床效果和应用价值.方法 2008年1月至2011年6月收集15例下肢动脉狭窄闭塞患者,共计17条股浅动脉,右侧10条,左侧7条,病变段长度9 ～ 18 cm,平均(12.5 ± 6.8)cm,经腘动脉穿刺逆行治疗同侧股浅动脉近端狭窄和闭塞,采用经皮腔内血管成形术加支架植入.术后随访3 ～ 24个月.结果 17条股浅动脉的治疗成功率为100%,无严重并发症发生,术后缺血引起的症状消失或明显改善,随访3 ～ 24个月,血流仍保持通畅,为89.47%(17/19),治疗前后踝肱指数分别为0.15 ～ 0.48(平均0.28)和0.69 ～ 1.05(平均0.88),两者间差异有统计学意义(P ＜ 0.05).结论 经腘动脉入路逆行治疗同侧股浅动脉近端狭窄和闭塞是一种安全有效的方法.%Objective To investigate the clinical effect and application of retrograde catheterization via politeal artery in treating ipsilateral superficial femoral artery occlusive diseases. Methods During the period from Jan. 2008 to June 2011, 15 patients with superficial femoral artery occlusive diseases were collected. A total of 17 narrowed or obstructed superficial femoral arteries were detected, including right (n = 10) and left (n = 7) femoral arteries. The length of the diseased artery ranged from 9 to 18 cm, with a mean of (12.5 ± 6.8) cm. Percutaneous angioplasty (PTA) through ipsilateral retrograde catheterization via politeal artery together with stent implantation was performed to reopen the narrowed or obstructed superficial femoral arteries. After the procedure all patients were followed up for 3-24 months. The clinical results were analyzed. Results The therapeutic success rate was 100% (17/17). No serious complications occurred. After the treatment, the ischemic symptoms were markedly improved or even disappeared. In 89.47% of patients (17/19) the superficial femoral arteries remained patent during the follow-up period. The preoperative ankle brachial index(ABI) was 0.15 - 0.48(mean 0.28), while the postoperative ABI was 0.69 - 1.05 (mean 0.88). The difference in ABI between pre-operation and post-operation was statistically significant (P < 0.05). Conclusion For the treatment of superficial femoral arterial occlusive diseases, PTA through ipsilateral retrograde catheterization via politeal artery together with stent implantation is a safe and effective therapy.