血栓闭塞性脉管炎的腔内治疗

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.     

血栓闭塞性脉管炎的腔内治疗

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.     

血栓闭塞性脉管炎的腔内治疗

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.     

血栓闭塞性脉管炎的腔内治疗

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.     

血栓闭塞性脉管炎的腔内治疗

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.     

血栓闭塞性脉管炎的腔内治疗

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.     

血栓闭塞性脉管炎的腔内治疗

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.     

血栓闭塞性脉管炎的腔内治疗

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.     

血栓闭塞性脉管炎的腔内治疗

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.     

血栓闭塞性脉管炎的腔内治疗

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.     

杂交技术治疗复杂下肢动脉硬化闭塞症疗效分析

目的:探讨采用杂交技术治疗复杂下肢多节段动脉硬化闭塞症的临床疗效。方法:分析2014年3月—2014年9月行杂交技术治疗的30例(30条患肢)复杂下肢动脉硬化闭塞症患资料。30例患者病变部位累及主-髂动脉、股-腘动脉、股深动脉以及膝下动脉;均行血管腔内修复术,20例行动脉内膜剥脱术,10例行动脉取栓术,8例加行股深动脉成形术。结果:30例杂交手术均获得成功,技术成功率100%,围手术期并发症发生率30%(9/30)。临床成功率为96.67%,术后平均踝肱指数较术前提高了0.37±0.19。术后6、12个月一期通畅率分别为90%、73%,12个月救肢率为97.67%。结论:杂交技术治疗复杂下肢动脉硬化闭塞症具有较高的短期通畅率和救肢率。     

TASC C/D型主髂动脉硬化闭塞症的杂交手术治疗

目的:评价杂交手术治疗TASC C/D型主髂动脉硬化闭塞症的临床疗效。方法:回顾性分析2012年5月—2014年5月采用杂交手术治疗的48例TASC C/D型主髂动脉硬化闭塞症患者(共66条患肢)临床资料,其中TASC C型22例,D型26例,观察围手术期情况,比较不同Fontaine分级患者血管再通情况并分析影响一期通畅率的因素。结果:48例(66条患肢)杂交手术均获得成功,手术成功率100%,1例患者因下肢坏疽处感染严重而于术后5 d行截肢手术,无死亡病例,围手术期并发症发生率16.67%。与术前比较,术后间歇性跛行距离(568 m vs.92 m)与踝肱指数(0.75 vs.0.25)均明显增加(均P0.05)。平均随访24个月,术后6个月和1、2年的一期通畅率分别为95.45%、90.91%、87.88%,二期通畅率分别为98.48%、96.97%、92.42%;Fontaine II、III级患者一期通畅率均高于IV级患者(P=0.036、0.015),而II、III级患者之间一期通畅率无统计学差异(P0.05);高脂血症和糖尿病是影响术后一期通畅率的独立危险因素(P=0.026、0.003)。结论:杂交手术是治疗TASC C/D型主髂动脉硬化闭塞症的安全、有效方式。     

复杂股腘动脉硬化闭塞症的杂交手术治疗

目的:评价杂交手术治疗复杂股腘动脉硬化闭塞症的疗效。方法:回顾性分析2013年3月—2015年6月行杂交手术治疗的56例复杂股腘动脉硬化闭塞症患者(65条患肢)的临床资料。用踝肱指数(ABI)、Rutherford分级、通畅率等指标对手术效果进行综合评价,采用Kaplan-Meier法分析术后患肢通畅率。结果:56例患者(65条患肢)手术均取得成功,无截肢或死亡病例,围手术期并发症发生率14.29%(8/56)。术后平均ABI较术前升高(0.76vs.0.28),平均间歇性跛行距离从术前168m提高至530m,差异均有统计学意义(P0.05);Rutherford分级不同程度提高。随访时间12~33个月,术后6个月及1、2年的一期通畅率分别为93.85%、81.54%、70.77%,二期通畅率分别为98.46%、95.38%、90.77%。结论:杂交手术治疗复杂股腘动脉硬化闭塞症安全有效。     

累及股动脉分叉的多节段下肢动脉硬化闭塞症的杂交手术治疗

目的:探讨杂交手术治疗累及股动脉分叉的多节段下肢动脉硬化闭塞症的临床疗效。方法:回顾2010年10月—2014年12月采用杂交手术治疗46例累及股动脉分叉的多节段下肢动脉硬化闭塞症患者(共47条患肢)的资料。分析相关临床指标,以及病变程度与手术方式对一期通畅率的影响。结果:手术成功率98%(46/47),围手术期无死亡病例,平均踝肱指数由术前的0.34±0.16上升到术后的0.69±0.11。平均随访21.8个月,随访率93%(43/46),累积一期通畅率为67.4%。KaplanMeier分析显示,患肢Fontaine期越高,一期通畅率越低;当患肢手术区域的近、远端都进行腔内干预时,其一期通畅率低于仅在其近端或远端一侧进行干预者(均P0.05)。结论:对于累及股动脉分叉的多节段下肢动脉硬化闭塞病变,杂交手术是一种有效的治疗手段,符合个体化治疗原则。     

膝下动脉球囊血管成形术治疗重症下肢缺血的临床研究

目的 评价膝下动脉闭塞首选球囊血管成形术的临床治疗效果.方法 2005年12月至2009年5月,对于连续收治且符合手术指征的54例(61条肢体)膝下动脉重度狭窄或闭塞的重症下肢缺血患者,采用膝下动脉球囊血管成形术进行治疗.其中男性37例,女性17例,平均年龄66岁.术前踝肱指数平均0.43±0.27.根据病变部位选择手术方法,膝下动脉病变首选球囊血管成形术,合并髂股动脉病变同时进行血管重建(支架置入或动脉旁路术).结果 髂股动脉重建(28条肢体行支架置入,5条肢体行动脉旁路术)均一期成功.膝下动脉球囊血管成形术57条肢体获得一期成功,技术成功率93.4%.围手术期主要并发症为小腿血肿3例(4.9%),膝下截肢2例(3.3%).术后踝肱指数增加至0.86±0.21,与术前相比差异有统计学意义(P<0.01).本组平均随访时间(16±11)个月,一期通畅率61.1%,21条肢体发生再狭窄(38.9%),其中10条肢体再次接受外科干预,二期通畅率75.9%.截肢3条肢体,总的救肢率91.8%.结论 球囊血管成形术是治疗重症下肢缺血安全有效的方法,可以作为膝下动脉病变首选的外科干预手段.     

血栓闭塞性脉管炎的腔内治疗

目的 探讨血栓闭塞性脉管炎(thromboangitis obliterans,TAO)的腔内治疗方法.方法 总结上海中山医院血管外科2006年4月至2008年5月收治TAO患者16例(18条下肢)TAO患者的临床资料.对病变肢体行下肢造影,根据术前CTA结果显示的流入道和流出道情况行置管溶栓术和球囊扩张成形术.结果 本组16例患者18条肢体行球囊扩张成形术(percutaneous transluminal plasty,PTA),3条肢体术后无明显改善,其中1例手术2周后行膝上截肢术.FFA即时成功率为83.34%(15/18).术后15条患肢皮温明显升高,间歇性跛行消失或跛行距离延长,静息痛消失或明显减轻,9例足背或胫后动脉搏动恢复.术后1周踝/肱指数由术前0.33±0.16恢复至0.79±0.23.8例有足趾坏死者渗出消失、创丽愈合.术后随访16例,随访率100%,随访时间2～24个月,平均随访10.84个月.以下肢CTA和A/BI检杏行术后随访,术后3个月的通畅率为81.33%,1年通畅率为60.23%.结论 TAO患者行PTA能改善患肢血供,促进溃疡及创面的愈合,增加保肢率,降低截肢平面.近期效果满意,是一种可供选择的新的治疗途径.     

一站式杂交手术治疗动脉硬化闭塞症复杂病变

目的探讨一站式杂交手术治疗下肢动脉硬化闭塞症（arteriosclerosis obliterans,ASO）多节段复杂病变的临床效果。方法2005年1月-2007年12月采用一站式杂交手术治疗ASO多节段病变患者22例,行股总动脉切开动脉内膜切除或Fogarty导管取栓＋PTA＋STENT（逆行）＋股腘旁路或股股旁路10例,切开股总动脉Fogarty导管取栓或动脉内膜切除术＋PTA＋STENT（顺行）7例,切开股总动脉行动脉内膜切除术同时逆行、顺行PTA＋STENT5例。结果手术成功率为100%,术后静息踝肱指数由术前0.38升高0.61（P〈0.0001）;运动后踝肱指数由术前0.30升至0.60（P〈0.0001）。分别于术后3、6、9、12个月进行临床评估及彩超检查,1例11个月死于重症肺炎,2例再狭窄,1年通畅率90.5%（19/21）。结论一站式杂交手术治疗多节段复杂病变的下肢动脉硬化闭塞症患者安全、创伤小、通畅率高。     

下肢动脉硬化闭塞症腔内治疗后支架内再狭窄的治疗

目的:探讨下肢动脉硬化闭塞症(ASO)腔内治疗后支架内再狭窄的治疗体会。方法:回顾性分析2012年6月至2014年12月收治的支架内再狭窄的31例下肢ASO患者(49条肢体)资料,其中狭窄病变37条肢体,闭塞病变12条肢体;病变长度8.5~35 cm,平均(25.2±7.5)cm。结果:所有患者均接受腔内治疗,包括单纯球囊扩张成形术35例,球囊扩张后导管溶栓术3例,球囊扩张后支架植入术3例,导管溶栓后球囊扩张术7例,斑块旋切术1例。术后所有患者症状均不同程度缓解,平均踝肱指数较术前明显升高(P0.05)。28例获得随访3~32个月,平均(16.2±5.8)个月,期间出现再狭窄6例(21.4%),均再次行球囊扩张成形术,无截肢及死亡病例。结论:结合其他腔内疗法,球囊扩张术治疗下肢动脉支架内再狭窄疗效满意。     

腘以远动脉闭塞所致下肢严重缺血的血供重建

目的 评价腘以远动脉闭塞所致下肢严重缺血(critical limb ischemia,CLI)的血供重建.方法 回顾性分析2003年12月至2009年1月,腘以远动脉闭塞所致CLI行经皮血管腔内成形(percutaneous transluminal angioplasty,PTA)和开放性重建(open reconstruction,OR)术的患者,详细记录患者的病史、病变特点、手术过程、并发症和随访信息.采用Kaplan-Meier生存分析重建血管通畅率和救肢率.结果 本组腘以远动脉闭塞所致CLI患者共167例,182条患肢.123条动脉硬化闭塞(arterios-clerosis occlusions,ASO)的患肢行腘以远动脉PTA治疗,33条血栓闭塞性脉管炎(thromboangiitis obliterans,TAO)和23条ASO患肢行腘以远动脉OR手术.PTA再管化通道6、12、24个月的通畅率分别是67%、54%和49%,其救肢率分别是91%、85%和78%,OR术后移植物6、12、24个月的通畅率分别是90%、83%和79%,其救肢率分别是92%、87%和80%,PTA重建血管的通畅率低于开放性手术(P＜0.05),但PTA和OR术的救肢率差异无统计学意义(P＞0.05).结论 对腘以远动脉ASO的CLI患者,PTA有效、安全,可作为首选治疗方式.PTA治疗失败可选择OR术.对TAO患者腘以远动脉闭塞者OR术仍是最好的治疗选择.

Abstract：

Objective To assess reconstructive options for critical limb ischaemia in infrapopliteal arteries. Methods A retrospective review of all CLI patients who underwent infrapopliteal reconstruction was carried out. Patient history, demographics, procedure details, complications, and follow-up information were collected and analyzed. Patency, limb salvage rate was determined by Kaplan-Meier analysis. Results During the period (from December 2003 to January 2008 ), 123 CLI patients with arteriosclerosis occlusions were treated on an intention-to-treat basis with infrapopliteal percutaneous transluminal angioplasty (PTA).Thirty-three thromboangiitis obliterans and twenty-three arteriosclerosis occlusions suffering CLI were treated by infrapopliteal bypass procedures. Primary patency and limb salvage rate of infrapopliteal PTA at 6, 12 and 24 months was 67%, 54%, 49% and 91%, 85%, 78% respectively, Primary patency and limb salvage rate of infrapopliteal surgical bypass at 6, 12 and 24 months was 90%, 83%, 79% and 92%,87%, 80% respectively, the patency of infrapopliteal PTA was lower than infrapopliteal surgical bypass (P ＜0. 01 ), but the limb salvage rate of infrapopliteal PTA and open surgery was no significant difference (P ＞ 0. 05 ). Conclusion Endovascular treatment (PTA) in patients with infrapopliteal arteriosclerosis occlusions and critical ischaemia is safe, effective. Infrapopliteal PTA can be used as the choice of therapy and surgical bypass reserved in those endovascular treatment failed. While in CLI patients with thromboangiitis obliterans infrapopliteal artery bypass remains the best treatment option.     

经皮腔内血管成形术联合血管内支架治疗下肢动脉硬化闭塞症

目的观察经皮腔内血管成形术(PTA)联合血管内支架治疗下肢动脉硬化闭塞症(ASO)的临床疗效。方法 2007年1月～2009年12月,对采用股动脉血管内支架治疗的26例下肢ASO患者的跛行距离及踝肱指数(ABI)进行观察。结果术后1个月,间歇性跛行距离由(124.6±32.2)m增加到(552.7±137.5)m,ABI由0.62±0.04增加到0.94±0.06,手术前后比较差异均有统计学意义(P<0.05)。术后1年支架通畅率为100%,2年通畅率为92.3%。结论 PTA联合血管内支架置放是治疗下肢ASO的有效方法。