摘要
目的 探讨动脉腔内自膨式镍钛合金支架一期植入治疗股浅动脉硬化闭塞症的疗效。方法 对2004年2月～2006年1月动脉腔内一期自膨式镍钛合金支架治疗的17例（21条下肢）股浅动脉硬化闭塞症进行回顾性研究。FontaineⅡb期（中、重度间歇跛行）4例,Ⅲ期（静息痛）6例,Ⅳ期（组织缺损）7例（其中足部溃疡4例,足趾坏疽3例）。股浅动脉病变的平均长度5.8 cm（0.5～16 cm）。病变TASC分型A型9条,B型4条,C型7条,D型1条。通过彩色血管超声和（或）动脉造影观察病变段动脉术前、术后的影像学改变分析支架通畅率,分析术前、术后临床症状的改善情况,以临床改善率和保肢率来评价临床疗效。结果 17例（21条下肢）共置入自膨式镍钛合金支架28枚,术后即刻造影显示支架全部通畅,技术成功率100%。术后1周血流动力学成功率（指踝/肱指数增加超过0.15的肢体）为81%（17/21）,临床改善率95%（20/21）。17例平均随访15.7（12～35）月。1例术后6个月死于脑梗死;1例术后3个月支架闭塞,取栓后再通已达13个月;2例分别于术后3和4个月支架闭塞,改行股-膝下腘动脉人工血管旁路术成功;2例分别于术后8和12个月支架闭塞行膝下截肢。本组1年一期通畅率为75%（15/20）,二期通畅率80%（16/20）,临床改善率为75%（15/20）,严重缺血肢体（表现为静息痛和肢体坏疽者）的保肢率为88%（14/16）。结论 自膨式镍钛合金支架一期植入治疗股浅动脉硬化闭塞症有较满意的中期疗效,可作为治疗股浅动脉病变的首选方法,尤其是对无法耐受动脉旁路移植手术的患者。
Objective To explore mid-term results of endoluminal self-expanding nitinol stents primarily implanted in the superficial femoral artery （SFA） for treating lower limb ischemia. Methods We conducted a retrospective analysis on 17 cases of atherosclerotic occlusive disease of the superficial femoral artery （21 lower limbs） treated by a primary implantation of self-expanding nitinol stents from February 2004 to January 2006. According to tbe Fontaine stages, there were 4 stage Ⅱ b cases （ moderate to severe intermittent claudication） , 6 stage Ⅲ cases （rest pain） , and 7 stage Ⅳ cases （4 cases of ulcer and 3 cases of gangrene）. The mean lesion length was 5.8 cm. On the basis of the TransAtlantic Inter-Society Consensus （TASC） femoropopliteal classification, the lesions were classified as type A in 9 limbs, type B in 4 limbs, type C in 7, and D in 1. Follow-up examinations with color duplex ultrasound and/or arteriography were carried out to determine the stent patency. The improvement of clinical symptoms after operation was analyzed. The clinical effects were assessed with the improvement rate and the limb salvage rate. Results A total of 28 stents was implanted in the SFA. Angiography immediately following the implantation showed patent stenting in all the cases, the technical success rate being 100% . At 1 week after the operation, the hemodynamic sueeess rate （ defined as a rise in the ankle/brachial index 〉 0.15） was 81% （17/21） and the clinical improvement of symptoms was achieved in 95% （20/21） of cases. The 17 cases were followed up for a mean of 15.7 months （range, 12 -35 months）. One patient died of cerebral infarction at 6 months postoperatively. One patient with stent occlusion at 3 months after operation was given an embolectomy （the artery has remained patent for 13 months）. Stent occlusion also happened in 2 patients （ at 3 and 4 months after operation, respectively） , on whom a subsequent infragenicular femoropopliteal bypass was operated, and in 2 other patients （at 8 and 12 months after operation, respectively） , on whom a below- knee amputation was operated. At one year postoperatively, the patency rate was 75% （15/20） after primary operation and 80% （16/20） after re-operation. The rate of clinical improvement of symptoms was 75% （15/20）. The limb salvage rate in patients with critical limb ischemia was 88% （ 14/16）. Conclusions Primary angioplasty with self-expending nitinol stent implantation is a safe, minimally invasive, and effective method, which can be used as the first choice for femoral arterial occlusive diseases, especially in senile patients who cannot tolerate bypass procedures.
出处
《中国微创外科杂志》
CSCD
2007年第7期612-614,共3页
Chinese Journal of Minimally Invasive Surgery
基金
首都医学发展基金(2002-1013)
关键词
自膨式支架
下肢缺血
动脉硬化闭塞症
Self-expanding stent
Lower extremity ischemia
Atherosclecrotic occlusive disease
