下肢CTA对股-腘动脉SilverHawk斑块旋切术的评估价值

摘要

目的：对比分析CTA与DSA技术在用于评价SilverHawk斑块旋切系统对下肢动脉狭窄闭塞的治疗及随访方面的价值。方法分析2014年9月至2015年10月期间,在天津市天津医院血管外科接受SilverHawk斑块旋切术治疗股-腘动脉粥样硬化闭塞症的28例患者资料。回顾性分析患者术前及术后患肢ABI情况、CTA 图像中病变血管狭窄率,并与斑块旋切术中 DSA 示病变狭窄率进行比较。结果28例病例股-腘动脉TASCⅡ分类为C型18例,D型10例。术前狭窄节段长度为3.2~12.8 cm,平均长度(6.6±2.4)cm。术前狭窄率为75%~100%,平均狭窄率为(92±6)%,狭窄程度均为4级。术后残余狭窄率为15%~35%,平均狭窄率为(25±7)%。斑块旋切术后患肢动脉狭窄率明显降低(P<0.05),术后患肢ABI较术前明显升高( P<0.05)。斑块旋切后DSA示管腔轻微狭窄10例,轻度狭窄18例,中度狭窄0例,重度狭窄0例；术后复查CTA显示术后管腔残余狭窄程度结果为轻微狭窄8例,轻度狭窄20例,中度狭窄0例,重度狭窄0例。 CTA观察狭窄程度与DSA观察结果具有较好的一致性(k=0.650)。结论CTA适用于评价SilverHawk斑块旋切术前情况及术后早期疗效,筛选适合手术的病例有助于提高手术成功率及远期通畅率,远期随访尚需进一步研究。%Objective Compare the assessment value of CTA and DSA technology in evaluating the SilverHawk atherectomy system. Methods This study analyzed the clinical datas of 28 patients who accepted femoral-popliteal artery plaque excision with SilverHawk atherectomy system in Tianjin Hospital during Sep 2014 and Oct 2015. Retrospectively analysis the situation of preoperative and postoperative ABI, stenosis rate in CTA image, and compare with the DSA.Results In the 28 patients, 18 cases were Type C, 10 cases were Type D. The preoperative length of stenosis ranged from 3.2 to 12.8cm, (6.6±2.4) cm on average. Preoperative stenosis rate was 75%~100%, (92±6)% on average, narrow degree were in grade 4. Postoperative residual stenosis rate was 15%~35%, (25±7)% on average. After plaque excision by SilverHawk atherectomy system, artery stenosis rate significantly decreased (P<0.05), postoperative ABI significantly increased than preoperative (P<0.05). After plaque excision, 10 cases were slight stenosis, 18 cases were mild stenosis, 0 case was moderate stenosis and 0 case was severe stenosis by DSA. And 8 cases were slight stenosis, 20 cases were mild stenosis, 0 case was moderate stenosis and 0 case was severe stenosis by CTA. There was good consistency ( k=0.650) between CTA and DSA in observing the degree of stenosis. Conclusions Lower limb artery CT angiography can be used to evaluate preoperative situation and early postoperative efficacy in SilverHawk atherectomy. Filtered suitable cases use CTA could improve the success rate of surgery and long-term patency rate, long-term follow-up need further research.