杂交技术在治疗TASC D型周围动脉闭塞性疾病中的应用

目的：总结杂交技术在治疗TASC D型周围动脉闭塞性疾病的治疗经验。 方法：回顾性分析2009年10月—2013年12月间采用杂交技术治疗的22例TASC D型周围动脉闭塞性疾病患者（24条肢体）的临床资料，其中采用髂动脉支架植入术+股总动脉内膜剥脱术（含股深动脉内膜剥脱术）+股深动脉成形术+股腘动脉人工血管旁路术治疗患者12例，采用股总动脉内膜剥脱术（含股深动脉内膜剥脱术）+股腘动脉人工血管旁路术+胫前动脉、胫后动脉球囊扩张术治疗患者4例，采用Fogarty导管取栓术+髂动脉支架植入术+股总动脉内膜剥脱术（含股深动脉内膜剥脱术）治疗患者6例。 结果：所有的患者均获得技术上的成功，围手术期无患者死亡，术后患肢疼痛改善，皮温升高，平均踝肱指数从术前的0.38升至术后的0.75。18例患者获随访3~28个月，2例患者术后发生人工血管旁路血栓形成，1例患者术后发生支架内再狭窄，其余患者未发生人工血管或支架相关并发症。 结论：杂交技术微创、安全、有效，是处理TASC D型周围动脉闭塞性疾病的合理选择，尤其适用于无法进行单纯腔内治疗的高危患者。

Application of hybrid procedure in treatment of TASC type D peripheral artery diseases

Objective: To present the experience in hybrid procedure for TASC type D peripheral artery diseases (PAD). Methods: The clinical data of 22 patients (24 limbs) undergoing hybrid procedure for TASC type D PAD from October 2009 to December 2013 were retrospectively analyzed. Of the patients, 12 cases underwent iliac artery stent placement plus common femoral endarterectomy (including deep femoral endarterectomy) and profundaplasty with femoropopliteal prosthetic bypass, 4 cases underwent common femoral endarterectomy (including deep femoral endarterectomy) plus femoropopliteal prosthetic bypass and balloon dilatation of the anterior tibial artery or posterior tibial artery, and 6 cases underwent Fogarty catheter embolectomy plus iliac artery stent placement and common femoral endarterectomy (including deep femoral endarterectomy). Results: Technique success was achieved in all patients, and no perioperative death occurred. After operation, the pain was relieved and skin temperature was increased in the affected limbs, and the average ankle brachial index was increased from the preoperative 0.38 to postoperative 0.75. Eighteen patients were followed-up for 3 to 28 months; 2 cases developed postoperative thrombosis in the prosthetic bypass and one case developed stenosis in the stent, while no prosthesis- or stent-related complications occurred in any of the remaining cases. Conclusion: Hybrid procedure is minimally invasive, effective and safe. It is an appropriate choice for TASC D PAD, especially for those with high risk for single endovascular therapy.