摘要
目的探讨AcoStream用于急性下肢缺血性疾病治疗的有效性和安全性。方法回顾性分析2022年1月至2023年6月在我院行下肢动脉AcoSream吸栓治疗的21例急性下肢缺血患者的临床资料。左侧肢体栓塞10例,右侧肢体栓塞11例。病变部位:髂动脉段5例,股动脉段11例,腘动脉段10例,膝下动脉段13例。Rutherford分级:ⅡA级5例,ⅡB级15例,Ⅲ级1例。术前踝肱指数(ankle brachial index,ABI)0.31~0.73,平均0.49±0.11。记录并分析技术成功率、临床成功率、ABI变化,观察不良反应和并发症情况。结果本组使用AcoStream血栓抽吸系统均顺利完成经皮机械性血栓清除术(percutaneous mechanical thrombectomy,PMT),术后病变血管残余狭窄均<30%,技术成功率为100%。1例PMT后虽有残留血栓,但疼痛缓解,术后立行导管接触性溶栓治疗,3 d后残留血栓清除;13例联合球囊扩张,6例植入支架,6例联合行Rotarex机械血栓清除。本组20例获得临床成功,临床成功率为95.24%,临床无效1例。术后ABI恢复至0.76±0.19,较术前明显改善(t=6.733,P<0.05)。术中均未发生远端动脉栓塞。4例吸栓时病变部位发生夹层,植入支架后好转。未见动脉穿孔、急性血栓形成、穿刺点渗血等并发症。21例患者均获随访,时间1~6个月,至随访结束无复发。结论AcoStream治疗急性下肢缺血安全有效,可快速清除血栓及栓子,在明确病变部位、病变性质、缺血程度后及时采用单一或多种方式联合治疗,对挽救患者肢体具有重要的临床价值。
Objective To explore the effect and safety of AcoStream thrombus aspiration system in the treatment of acute lower limb ischemia(ALLI).Methods The clinical data of 21 cases with ALLI underwent thrombus aspiration with AcoStream system in percutaneous mechanical thrombectomy(PMT)admitted from January 2022 to June 2023 were retrospectively analyzed.Among them,left limb embolization occurred in 10 cases,and right limb embolization occurred in 11 cases.Lesion sites located in iliac artery segment in 5 cases,femoral artery segment in 11 cases,popliteal artery segment in 10 cases and infrapopliteal artery segment in 13 cases.According to Rutherford classification,there were 5 cases of gradeⅡA,15 cases of gradeⅡB and 1 case of gradeⅢ.Preoperative ankle brachial index(ABI)ranged from 0.31 to 0.73,with a mean of 0.49±0.11.Technical success rate,clinical success rate and ABI changes were analyzed,and adverse reactions and complications were observed.Results PMT was successfully completed with the AcoStream thrombus aspiration system,and the residual stenosis of the lesion vessels was less than 30%after the operation,with a technical success rate of 100%.After PMT,residual thrombus was found in one case with the pain relieved,and performed catheter-director thrombolysis(CDT)immediately,and achieved residual thrombus-free 3 days after the CDT.Combined balloon dilatation was performed in 13 cases,stent implantation was in 6 cases,and Rotarex mechanical thrombectomy was in 6 cases.Then the clinical success was achieved in 20 cases with the clinical success rate of 95.24%,and clinical failure occurred in 1 case.The mean ABI was increased from 0.49±0.11 preoperatively to 0.76±0.19 postoperatively,with significant difference(t=6.733,P<0.05).No distal artery embolization occurred during the operation.The lesion site was dissected in 4 cases during aspiration,and improved after stenting.There were no complications such as arterial perforation,acute thrombosis and bleeding at puncture point.No recurrence occurred during 1 t
作者
张钰涵
何文烨
王路遥
张大伟
郝清智
ZHANG Yuhan;HE Wenye;WANG Luyao;ZHANG Dawei;HAO Qingzhi(The First Clinical Medical College of Shandong University of Traditional Chinese Medicine,Jinan 250000,Shandong,China;Department of Peripheral Vascular Disease,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250000,Shandong,China)
出处
《中国现代手术学杂志》
2024年第3期212-217,共6页
Chinese Journal of Modern Operative Surgery
基金
山东省自然科学基金项目(ZR2021MH356)
教育部科技发展中心产学研创新基金(2021JH036)
齐鲁医派中医学术流派传承项目。
