Viabahn覆膜支架在下肢动脉缺血性病变的临床研究

发布时间：2018-02-02 11:10

本文关键词： 下肢动脉缺血性病变 Viabahn覆膜支架腔内治疗　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：评估Viabahn覆膜支架在下肢动脉缺血性病变的腔内治疗的短期疗效。方法：回顾性分析了从2013年4月到2013年11月我们所治疗的下肢动脉硬化闭塞症患者17例（总共治疗了17条患肢），其中男性13例（76.5%），女性4例（23.5%）。平均年龄68.8±8.1岁(54-81岁)，缺血程度按Rutherford分级：2级2例（11.8%），3级5例（29.4%），4级5例（29.4%），5级5例（29.4%）。膝下流出道情况：0条膝下流出道5例（29.4%），1条膝下流出道2例（11.8%），2条膝下流出道4例（23.5%），3条膝下流出道6例（35.3%）。并存病情况：合并高血压的患者为11例（64.7%），合并糖尿病的为8例（47.1%），合并高血脂的为8例（47.1%），合并冠心病的为10例（58.8%）。病变按照血管的节段分：髂动脉的病变，2例（11.8%），股乆动脉的病变，11例（64.7%）,髂动脉合并股乆动脉的病变，4例（23.5%）,其中6例为裸支架植入术后再狭窄或闭塞（35.3%）。术前17条患肢平均ABI（Ankle/Brachial Index，踝肱指数）0.42±0.23。所有患者均在术前行下肢CTA和（或）动脉彩色多普勒超声明确下肢病变血管情况并测量病变的直径。大部分病例病变血管都采用.VASIR（Viabahn-Assisted Subintimal Recanalization，Viabahn辅助下的内膜下成形）技术。术后测定患肢的ABI，随访1月、3月、6月行动脉彩色多普勒超声或CTA评估通畅率，通过Rutherford分级的改善情况以及保肢率来评价疗效。结果：17条患肢手术的成功率达100%（17/17）。术后患者的平均ABI为：0.76±0.21，较术前患者的平均ABI明显升高（P＜0.05㖞。患者术后1个月，保肢率为100%（17/17）,3个月，，保肢率为100%（17/17）,6个月，保肢率为100%（17/17）。介入术后1个月，一期通畅率为100%（17/17）,3个月，一期通畅率为94.1%（16/17），二期通畅率为94.1%（16/17）,6个月，一期通畅率为70.6%（12/17），二期通畅率为88.2%（15/17）。结论：1.利用Viabahn覆膜支架治疗下肢动脉硬化闭塞症，手术的成功率高，有较高的保肢率及相对较高的通畅率。2.选择合适的Viabahn支架直径，保证较好的膝下流出道能够提高通畅率及保肢率。
[Abstract]:Objective: to evaluate the short-term efficacy of Viabahn-covered stent in the intracavitary treatment of arterial ischemic lesions of the lower extremities. Methods: from April 2013 to November 2013, 17 patients with arteriosclerotic obliteration of lower extremity were retrospectively analyzed. Among them, 13 cases were male and 4 cases were female. The average age was 68.8 卤8.1 years old and 54-81 years old. According to the Rutherford grade, 2 cases of grade 2 with 11.8 grade and 5 cases of grade 3 with grade 29.4 were found to have 5 cases of grade 29.44 and 5 cases of grade 5 of grade 29.44.The subgenu outflow tract was found in 5 cases with subgenu outflow tract in 5 cases with subgenicular outflow tract in 2 cases with subgenu outflow tract in 2 cases with 11.88% subknee outflow tract in 2 cases with subgenicular outflow tract in 4 cases and with 3 subknee outflow tract in 6 cases with 3 subknee outflow tract. There were 11 patients with hypertension, 8 with diabetes, 8 with hyperlipidemia, 10 with coronary heart disease, and 10 with coronary heart disease. The lesions were divided according to the segments of the blood vessels: iliac artery lesions in 2 cases, iliac artery lesions in 2 cases, and iliac artery lesions in 2 cases. Arterial lesions were found in 11 cases (64.7%), iliac artery combined with femoral lesions in 4 cases (23. 5%), among which 6 cases were restenosis or occlusion after bare stent implantation. Preoperative mean ABI(Ankle/Brachial index of 17 affected limbs and ankle brachial index (mBI) were 0. 42 卤0. 23. All patients were treated with lower limb CTA before operation. (or) arterial color Doppler ultrasound was used to determine the vascular status and diameter of lower extremity lesions. Most of the diseased vessels were treated with subintimal angioplasty assisted by Viabahn-Assisted Subintimal. The ABI of affected limbs was measured after operation and followed up 1. The patency rate was evaluated by arterial color Doppler ultrasound or CTA on March and June. The efficacy was evaluated by the improvement of Rutherford classification and limb salvage rate. Results the successful rate of operation on 17 affected limbs was 100 / 17. The average ABI of postoperative patients was 0. 76 卤0. 21, which was significantly higher than that of preoperative patients (P < 0. 05, P < 0. 05). One month after the operation, the limb salvage rate was 100% 17 / 17, 3 months, the limb salvage rate was 100 / 17 / 17, 6 months, the limb salvage rate was 100 / 17 / 17. One month after interventional surgery, the primary patency rate was 100 / 17 / 17, 3 months, the first stage patency rate was 94.116 / 17 / 17, the second stage patency rate was 94.11 / 16 / 17, 6 months, The patency rate of the first phase was 70.612 / 17, and the second was 88.2a / 17. Conclusion 1. The successful rate of lower extremity arteriosclerotic obliteration treated with Viabahn stent is high, the rate of limb salvage is higher and the patency rate is relatively high. 2. Choose the appropriate diameter of Viabahn stent. Better underknee outflow can improve patency rate and limb salvage rate.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R543.5;R445.1

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