复杂下肢动脉硬化闭塞症的腔内治疗及疗效分析
发布时间：2019-06-22 09:16
【摘要】：背景下肢动脉硬化闭塞症是全身动脉硬化病变的重要组成部分,以髂-股动脉及股-胭动脉等大中动脉最易受累,后期多累及胭动脉远端的动脉,病变类型及程度均较复杂。针对股胭动脉以及累计远端动脉的慢性闭塞性复杂病变,根据TASCⅡ分级,传统上倾向于行开发性手术治疗,然而目前的临床实践上已纳入腔内介入治疗范围。因此在股胭动脉分型的复杂下肢动脉硬化闭塞症上,应用腔内血管成形术治疗的适应证仍未完善。目的探讨下肢动脉硬化闭塞症股胭动脉分型的复杂病变,结合不同类型病变应用腔内血管成形术治疗的适应证和疗效分析。方法采用回顾性对照分析的方法,收集我院于2011年1月至2014年10月收治的42例行腔内血管成形术治疗的复杂下肢动脉硬化闭塞症患者。病例术前影像学表现为股胭动脉分型TASCⅡ C或D级,临床表现符合Fontaine较重的Ⅱ期,以及Ⅲ、Ⅳ期,分析各风险因素。术后观察手术成功率,住院期间并发症发生率。对比手术前后患肢踝肱指数(ABI)变化情况,并进行t检验。所有病例术后进行门诊检查或电话询问方式随访3-18个月,对临床症状改善情况进行分析,观察中短期术后通畅率。结果所有42例患者行腔内血管成形术,手术成功率为92.8%,住院期间并发症发生率为19%。术后1周患者ABI较术前有显著性差异。42例患者术后随访3-18个月,大部分患者的临床症状得到改善,中短期通畅率为88%。结论1.在掌握腔内治疗复杂下肢动脉硬化闭塞症的适应证的前提下,应用腔内血管成形术可作为推荐的治疗方案。对于传统上适合或者不适合行开放性手术治疗的复杂下肢动脉硬化闭塞症患者,应用腔内治疗均可作为一种安全有效的治疗手段。2.目前的TASCⅡ分级标准已经对下肢动脉闭塞性病变的分类诊断作出了详细描述,但是股胭动脉的慢性闭塞性复杂病变的分类仍有待完善。同时综合影像学特征以及临床症状的表现,才能掌握腔内治疗的适应证,并有针对性的选择腔内血管成形术的手术方式。3.腔内介入治疗的手术成功率高,并发症少,短-中期术后通畅率满意。此类复杂性病变的中长期治疗效果仍需进一步观察。
[Abstract]:In the background, limb arteriosclerosis obliteration is an important part of systemic arteriosclerosis. Iliofemoral artery and middle thigh artery are the most easily involved, and the distal artery of carmine artery is more involved in the later stage, and the type and degree of lesion are more complex. According to TASC II grade, the patients with chronic occlusive complex lesions of popliteal artery and cumulative distal artery are traditionally inclined to be treated by developmental surgery, but the current clinical practice has been included in the scope of intracavitary interventional therapy. Therefore, the indication of endovascular angioplasty is still not perfect in the complex arteriosclerosis obliteration of lower extremity in the classification of popliteal artery. Objective to investigate the complex lesions of femoral popliteal artery classification in patients with arteriosclerosis obliterans of lower extremity, and to analyze the indication and curative effect of endovascular angioplasty combined with different types of lesions. Methods from January 2011 to October 2014, 42 patients with complex arteriosclerosis obliterans of lower extremity treated with endovascular angioplasty were collected by retrospective comparative analysis. The preoperative imaging findings of the cases were TASC 鈪，
本文编号：2504444
[Abstract]:In the background, limb arteriosclerosis obliteration is an important part of systemic arteriosclerosis. Iliofemoral artery and middle thigh artery are the most easily involved, and the distal artery of carmine artery is more involved in the later stage, and the type and degree of lesion are more complex. According to TASC II grade, the patients with chronic occlusive complex lesions of popliteal artery and cumulative distal artery are traditionally inclined to be treated by developmental surgery, but the current clinical practice has been included in the scope of intracavitary interventional therapy. Therefore, the indication of endovascular angioplasty is still not perfect in the complex arteriosclerosis obliteration of lower extremity in the classification of popliteal artery. Objective to investigate the complex lesions of femoral popliteal artery classification in patients with arteriosclerosis obliterans of lower extremity, and to analyze the indication and curative effect of endovascular angioplasty combined with different types of lesions. Methods from January 2011 to October 2014, 42 patients with complex arteriosclerosis obliterans of lower extremity treated with endovascular angioplasty were collected by retrospective comparative analysis. The preoperative imaging findings of the cases were TASC 鈪，
本文编号：2504444
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