摘要
目的:总结内膜下血管成形术(SIA)治疗下肢动脉硬化闭塞症的疗效。方法:平卧位、局麻下,于病肢同侧顺行或逆向穿刺股总动脉,插入6F鞘管,造影证实闭塞病变。在电透荧屏监控下,通过鞘管插入5F的KMP导管,在0.035超硬导丝作用下,于闭塞端的侧壁内膜下开创一个夹层平面,随着导丝在内膜下向前延伸,其顶端会形成半圆形的环。然后,导管和导丝环通过内膜下的夹层持续前进;当到达闭塞段远端时,将KMP导管的顶端转向腔内,使导丝和导管进入真腔。然后退出导管,顺着导丝插入7mm×40mm或合适大小的球囊导管,应用709～811kPa压力,逐步扩张再管化段。术中如发现新形成的通道受压而呈弹性回缩现象,可以植入8mm×40mm或适当大小的镍钛合金自膨式支架。最后通过导管或鞘管造影,检测血流通道是否再建成功。结果:本组共13例,男9例,女4例;左下肢5条,右下肢6条,双下肢2例(4条),共15条肢体。11例中计13条肢体获得成功,成功率为86.7%。其中股动脉段闭塞5例(7条肢体),髂动脉闭塞段4例(4条肢体),胫闭塞段2例(2条肢体)。分别随访3～9个月(平均4.3月),均维持通畅。复查ABI为0.65～0.87,平均0.75,与术前比较有显著性差异(P<0.01)。结论:SIA是一种应用腔内血管外科技术治疗下肢动脉硬化闭塞症的新方法,操作简便微创,安全、有效而经济。
Objective To explore the applicability of subintimal angioplasty (SIA) for the treatment of atherosclerosis obliterans (ASO) in the lower extremities. Methods Patients were placed in supine position. Under local anesthesia, the procedure was started with an antegrade or retrograde puncture of the ipsilateral common femoral artery. After the placement of a 6-F catheter, digital subtraction arteriogram was performed to confirm the occlusive lesion. Under fluoroscopic control, guided by an 0.035-inch-diameter stiff guide wire, a 5-F KMP catheter was advanced towards the lesion by a subintimal route. When the distal part of the occluded segment was reached, the catheter tip was turned intraluminally to let the guide wire enter into the lumen. Withdraw the catheter,a balloon catheter (7 mm×40 mm or suitable) was passed over the wire . The neolumen created was dilated under a pressure of 709-811 kPa. If the neolumen was not satisfactory due to an elastic recoil of the vascular wall, a self-expanding stent (8 mm×40 mm or suitable) was implanted. An arteriogram was then performed to verify the subintimal route. Results Fifteen limbs were treated with SIA in 13 patients (9 men, 4 females) with 5 left lower extremities, 6 right ones and 2 cases of bilateral lesions. Technical success was achieved in 13 limbs of 11 patients (86.7%), with femoral occlusion in 7 limbs of 5 patients, iliac occlusion in 4 limbs of 4 patients, and poplito-tibial occlusion in 2 limbs of 2 patients. A fter a follow-up of 3-9 months(mean 4.3 months), all subintimel channels remained patent. Compared to the preoperative figures, the post operative values of the ABI index were 0.65-0.87 (mean 0.75) (P<0.01). Conclusions SIA is an extraluminal recanalization for the treatment of ASO in the lower extremities. It is a new minimally-invasive procedure: safe, easy to handle and economical, with satisfactory short-term effect. As a novel technique, further investigation for confirmation is needed.
出处
《外科理论与实践》
2005年第1期23-26,共4页
Journal of Surgery Concepts & Practice
关键词
血管成形术
经腔
支架
动脉硬化
闭塞性
Subintimal Angioplasty
Stent implantation
Atherosclerosis obliterans
