冠状动脉再狭窄家猪模型中普通肝素用量的探讨

目的 评价低、中度肝素化在冠状动脉再狭窄家猪模型中的应用效果,探讨该模型合理的普通肝素用量.方法 根据普通肝素用量将24只健康家猪随机分为低度肝素化组(100 U/kg)和中度肝素化组(150 U/kg)各12头.分别测定基础促凝时间(ACT)和静脉注射肝素后不同时间点ACT.比较两组的抗凝效果,术后压迫止血情况及术中、术后24 h的安全性.采用SPSS 10.0进行统计学分析.结果 中度肝素化组和低度肝素化组在静脉推注普通肝素后5 min ACT达到峰值(245.3±93.64 s对241.0±37.29 s,P=0.824),20 min时两组维持较高ACT值(191.8±53.06 s对184.6±42.82 s,P=0.707).30 min时中度肝素化组ACT值(193.9±58.95 s)无显著变化,而低度肝素化组ACT值(154.0±28.20 s)明显回落,与前者相比,差异有统计学意义(P=0.005).中度肝素化组术后徒手压迫止血时间显著长于低度肝素化组(17.7±2.96 min对14.3±4.44 min,P=0.042).两组术中和术后24 h均未发生冠状动脉事件.结论 在家猪冠状动脉再狭窄模型中,若手术时间控制在20min内,则低度肝素化(100 U/kg)既可保证手术的安全性又可缩短压迫止血时间.     

经皮冠状动脉介入治疗中比伐芦定与肝素钠的抗凝效果和安全性比较

目的比较经皮冠状动脉介入(PCI)治疗中应用比伐芦定与肝素钠抗凝的有效性和安全性。方法连续纳入100例择期PCI患者作为研究对象,随机数表法将患者分为比伐芦定组(50例)和肝素钠组(50例),分别于给药后15、30、60 min及手术结束时监测活化凝血时间(ACT),观察围术期出血事件及主要不良心血管事件(MACE)发生情况。应用SPSS 20.0统计软件进行数据分析。结果给药15 min后2组患者ACT值均达标。术中比伐芦定组ACT水平基本稳定维持在较高水平[15 min:(280.5±12.5) s;30 min:(279.5±5.5)s;60 min:(282.1±6.8)s;手术结束时:(275.3±9.9)s],而肝素钠组ACT水平持续下降[15 min:(276.6±6.1)s;30 min:(258.1±3.0)s;60 min:(241.8±8.6)s;手术结束时:(234.9±7.9)s],给药30 min后2组ACT值的差异均具有统计学意义(P0.001)。2组术中及术后24 h内出血事件及血栓性事件的发生率无统计学差异(P0.05)。结论比伐芦定与肝素钠在PCI术中均安全有效。应用比伐芦定ACT数值较为稳定;而应用肝素钠时ACT数值波动较为明显,建议间隔15 min复测ACT为宜。     

国产比伐卢定对急性冠状动脉综合征患者介入术中凝血功能的影响

目的:探讨国产注射用比伐卢定和普通肝素在急性冠状动脉综合征患者冠状动脉介入术中对凝血功能的影响。方法:入选95例择期行PCI的急性冠状动脉综合征患者,随机分为肝素组(n=49)和比伐卢定组(n=46),其中肝素组脱落3例,比伐卢定组脱落5例,比伐卢定组和肝素组各剔除6例。根据分组不同术中分别采用国产注射用比伐卢定或肝素抗凝。分别在用药前、用药后5 min、首次用药后30 min、停药后1 h及6 h检测活化凝血时间(ACT)。比较首次给药5min后和30min后的ACT达标率。结果:2组患者基线资料具有可比性,术前凝血指标差异无统计学意义(P>0.05),比伐卢定组和肝素组用药后ACT值迅速升高,2组5min和30minACT达标率相当,差异无统计学意义(P>0.05)。用药结束后比伐卢定组ACT值下降迅速,用药结束后1hACT值较肝素组显著降低,2组之间差异有统计学意义(P<0.05)。用药结束后6 h,2组ACT值下降至与基线相当,2组之间差异无统计学意义(P>0.05)。肝素组用药后5 min、30 min和1 h,ACT值的标准差均大于比伐卢定组。结论:与常规肝素抗凝相比,比伐卢定在PCI术中可以获得更稳定的抗凝效果,其作为抗凝剂用于PCI术中安全有效。     

老年患者经桡动脉介入治疗术后急性桡动脉闭塞危险因素分析

目的:观察老年患者(≥60岁)接受桡动脉冠状动脉介入诊疗(TRI)术后桡动脉急性闭塞(RAO)的发生率,并探讨影响老年患者TRI术后发生RAO的相关因素。方法:选择2006年8月至2009年2月,于北京安贞医院12病房择期TRI≥60岁的老年患者1 256例,根据术后是否发生RAO分为正常组和RAO组,通过多因素Logistic回归分析与RAO有关的危险因素。记录手术相关参数,包括桡动脉穿刺次数、鞘管型号、手术时间、术中肝素用量及术后桡动脉压迫止血时间。疑有桡动脉闭塞的患者通过多普勒超声确诊。结果:1.1 256例TRI患者急性RAO发生率2.2%(28/1256例)。与正常组相比,RAO组患者中女性、糖尿病和既往行TRI患者的比例较高,RAO组术中平均肝素用量明显低于正常组〔(3 826±523)IU vs.(7 425±980)IU,P=0.008〕,术后压迫时间长于正常组〔(378.9±35.4)min vs.264.7±43.2)min,P=0.003〕,且RAO组患者应用7F动脉鞘的比例较高(10.7%vs.1.9%,P=0.029);Logistic回归分析显示,7F动脉鞘管、肝素用量偏低及术后桡动脉压迫时间过长,是影响RAO发生的独立危险因素。结论:老年患者TRI术中选择尺寸合适的动脉鞘管、足够强度的抗凝治疗、避免术后过长时间的压迫止血等均有利于减少RAO的发生。     

达肝素与普通肝素对血浆抗凝血因子Xa活性及活化凝血时间影响的对比研究

目的 探讨冠心病患者择期PCI及冠状动脉造影术中应用达肝素替代普通肝素的可行性和有效性.方法 共人选拟行择期PCI的患者87例,分为普通肝素组(10 000 IU)、小剂量(5 000 IU)达肝素组和大剂量(10000 IU)达肝素组,分别于用药前及全部剂量的药物注射后10 min、20 min、1 h、2 h及4 h采血,测定活化凝血时间(ACT)及血浆抗凝血因子Xa活性.结果 (1)普通肝素组、小剂量达肝素组和大剂量达肝素组ACT均在全部剂量的药物注射后10 min升高至峰值,分别为524.68±278.32 s、191.26±39.35 s、304.20±42.71 s(P＜0.05);其后各组ACT开始逐渐回落,在4 h后降至最低.(2)三组抗凝血因子Xa活性均在药物全部注射后20 min达到峰值,分别为0.80±0.11 IU/mL、0.72±0.10 IU/mL及0.72±0.09 IU/mL,但各组问差异无统计学意义(P＞0.05).结论 与普通肝素相比,达肝素用于PCI中可达到手术所需抗凝效果.     

基于体重的肝素负荷剂量下体重指数对活化凝血时间的影响

目的 探讨在经皮冠状动脉介入(PCI)治疗中,基于体重的肝素负荷剂量下体重指数(BMI)对全血活化凝血时间 (ACT)的影响.方法 前瞻性入选男性冠心病患者 78例,年龄 45～77(63.86±6.89)岁,以 BMI 为依据将患者分为 4 组:A 组 20 例(15.57≤BMI＜23.03),B 组 20 例(23.03≤BMI＜25.35),C 组 18 例(25.35≤BMI＜27.68),D 组 20 例(BMI≥ 27.68).所有患者给予100U / kg 负荷全量肝素,并于术前、肝素负荷剂量后 5min、10min、30min、60min抽血,采用 Hemotec 法检测ACT值,以术前 ACT(ACT0)为基线,其余 ACT值与其差值分别标记为ΔACTs,MATLAB 软件计算ΔACT- 时间曲线 下面积.结果 负荷肝素后 ACT 达峰时间各不相同:33.33%位于 ACT5 时间点,51.33%位于 ACT10 时间点,15.34%位于 ACT30 时间点,各组间差异有统计学意义(P＜0.05).ΔACT-时间曲线下面积随着BMI增大而增大,各组间差异有统计学意义 (P＜0.01).结论 相对于低BMI 患者,基于实际体重给予负荷量肝素对于大BMI患者是过量的.     

肝素抵抗现象的研究进展

肝素应用于临床已有数十年的历史,目前仍然是很有效的抗凝药物,在冠状动脉介入治疗(PCI)、肺栓塞及心肺分流术中被广泛应用。近年来发现,部分患者在应用规定量肝素后,激活凝固时间(ACT)值达不到预期水平,即出现肝素抵抗(HR)现象,影响治疗效果,日渐引起临床医师的重视。本文就近年来此方面的研究作一综述。1HR的定义有学者把静脉应用肝素至600～700I U/kg时ACT仍达不到480s,称为HR〔1〕;而Levy〔2〕认为,临床上所观察到的是肝素的剂量-反应曲线,应将HR更名为“肝素的剂量反应变化”。2HR机制研究进展2.1HR与抗凝血酶-Ⅲ抗凝血酶-Ⅲ…     

择期经皮冠状动脉介入治疗患者普通肝素抗凝强度不足的预测因素

目的分析择期经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者使用普通肝素(unfractionated heparin,UFH)抗凝后活化凝血时间(activated clotting time,ACT)300 s的预测因素。方法连续入选2011年5月1日至2012年12月31日在北京协和医院行择期PCI且术中使用UFH抗凝的患者,根据首次静脉注射UFH 5 min时的ACT水平将患者分为抗凝不足组(ACT300 s)和对照组(ACT≥300 s),比较两组患者的临床和冠状动脉造影资料,分析抗凝强度不足的预测因素和预测界值。结果(1)共入选1062例患者,男752例(70.8%),女310例(29.2%),平均年龄(63.0±10.6)岁,平均体重(70.5±11.7)kg,UFH首次平均给药剂量(100.7±9.1)U/kg。(2)ACT均数为(299.1±82.9)s,中位数为285(240,352)s。其中,ACT300 s的患者598例(56.3%),ACT为300~350 s的患者183例(17.2%),ACT≥350 s的患者281例(26.5%)。(3)与对照组相比,抗凝不足组的ACT[(242.3±33.9)s比(372.3±68.8)s,P0.0001]、UFH剂量[(100.1±8.9)U/kg比(101.4±9.2)U/kg,P=0.03]和白蛋白水平[(39.7±4.2)g/L比(40.7±3.8)g/L,P=0.001]更低;而血小板计数[(219.6±62.5)×10~9/L比(208.9±66.7)×10~9/L,P=0.008]更高,差异均有统计学意义。(4)logistic回归分析显示,血清白蛋白水平(OR 0.940,95%CI 0.900~0.980,P0.01)和血小板计数(OR 1.003,95%CI 1.001~1.006,P=0.01)是ACT300 s的独立预测因素。(5)根据受试者工作特征曲线,血清白蛋白42 g/L和血小板计数215×109/L为预测ACT300 s的最佳界值。结论择期PCI患者术中使用UFH后出现抗凝强度不足的比例较高,基线血清白蛋白和血小板计数是抗凝强度不足的独立预测因素。     

国产比伐芦定对择期冠状动脉支架置入患者术中凝血功能的影响

目的探讨国产注射用比伐芦定对择期冠状动脉支架置入(PCI)患者术中凝血功能的影响。方法入选2017年3月至2018年3月201例择期行冠状动脉支架置入术的患者,术中使用国产注射用比伐芦定抗凝,分别在用药前,用药后5 min、15 min、30 min、60min,停药前,停药后30 min及60min测定活化凝血时间(ACT)。结果给予比伐芦定5 min后,ACT值迅速达标,平均为(313.93±42.34)s。在随后的测定中,ACT值稳定,变异小,增加的幅度和持续时间能够满足冠状动脉介入治疗过程中抗凝的需要。停药后ACT值迅速下降,停药60 min时降至(165.12±19.20) s。住院期间仅有1例发生急性支架内血栓,余均无出血及主要心血管不良事件(MACE)发生。结论国产注射用比伐芦定应用于PCI术中抗凝,ACT值可迅速达标,使用过程中相对稳定,可保证手术过程中的充分抗凝效果。停药后代谢迅速,具有易调控的特点。     

非维生素K拮抗剂口服抗凝药对心房颤动射频消融术中活化凝血时间达标的影响

目的 研究非维生素K拮抗剂口服抗凝药(NOAC)对心房颤动(简称房颤)射频消融术中活化凝血时间(ACT)的影响，为制定更优的肝素负荷方案，提高ACT达标率提供一定依据。方法 按入选排除标准纳入自2019年10月至2021年11月在徐州医科大学附属医院心内科行射频消融术的房颤患者。术前抗凝方案为达比加群酯(110 mg, 2次/天)、利伐沙班(15 mg, 1次/天)。患者均给予100U/Kg首剂肝素，在肝素给药前及初始肝素给药后30min(30min-ACT)及其后每30min测定ACT值。按30min-ACT分为：达标组(ACT≥250 s),未达标组(ACT<250 s)。按基础ACT分为基础ACT≤145 s; 145 s相似文献   

改良家兔数字减影血管造影模型

目的寻找一种价格低廉效果良好的家兔介入实验动物模型。方法 10只家兔经颈总动脉插入留置针在数字减影血管造影术下观察其造影效果,解剖并测量双侧颈内动脉和股动脉直径的大小。结果 10只家兔颈内动脉与股动脉直径差异无统计学意义(P0.05),此种家兔改进介入模型能很好显示血管形态,与从股动脉入路比较操作方便,价格低廉,并能长期留置插管对其血管进行动态监测,适合蛛网膜下腔出血后继发性脑动脉痉挛的模型观察,且能在插管内注入各种栓塞物,制作脑动脉缺血模型。结论成功改进制作家兔数字减影模型。     

Femoral artery flow in deep vein thrombosis: hemodynamics of slow versus acute femoral vein occlusion

There are many reports of reduced flow in the femoral artery following acute occlusion of the femoral vein. Poorer results might also be expected in arterial reconstructive surgery for obliterative vascular disease, in the event of deep vein thrombosis (DVT) of the limb. It is likely that patients develop DVT by a slow process that is totally different from experimental acute occlusion of the femoral vein, which leads to reduction of flow in the femoral artery. To test this hypothesis, a model with slow and gradual femoral vein occlusion was used. The results of this study showed that there was only 13.5% reduction in femoral artery flow during a four-hour gradual occlusion of the femoral vein. This excludes the possibility that in the presence of gradually occurring processes such as DVT, there is a hemodynamic basis for reduced flow through the femoral artery or through a bypass.     

下肢动脉硬化性闭塞症多节段复杂病变的杂交手术治疗

目的:探讨下肢动脉硬化闭塞症(ASO)多节段复杂病变的治疗手段及临床疗效。方法:采用杂交手术治疗ASO多节段复杂病变,患者21例,切开股总动脉行髂动脉Fogarty导管取栓术+髂动脉血管腔内成形术(PTA)+支架(STENT)2例,髂动脉PTA+STENT+股总动脉内膜切除术(TEA)4例,髂动脉PTA+STENT+股总动脉TEA+股动脉Fogarty导管取栓术1例,髂动脉PTA+STENT+股总动脉TEA+股腘动脉人造血管旁路移植术1例,髂动脉PTA+STENT+股总动脉TEA+股浅动脉PTA+STENT2例,髂动脉PTA+STENT+股总动脉TEA+膝下动脉PTA2例,髂动脉PTA+STENT+股总动脉TEA+股深动脉扩大成形术2例,股总股浅动脉TEA+股浅动脉PTA+STENT3例,股浅动脉TEA+腘动脉PTA+膝下动脉PTA3例,先行膝下动脉远端流出道的PTA治疗,而后同期进行股腘动脉人造血管移植术1例。结果:手术成功率为100%,未出现严重并发症,踝肱指数(ABI)复查由0.31升至0.66(正常值0.53～0.91)。分别于术后3,6,9个月及12个月进行Ⅰ期临床评估及彩色多普勒超声检查,1例11个月死于急性心肌梗死,2例再狭窄,1年通畅率90%(18/20)。结论: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、创伤小及通畅率高。     

Different migratory and proliferative properties of smooth muscle cells of coronary and femoral artery

In the human coronary arteries, the intima begins to thicken from early adolescence and shows progressive thickening with age. We compared the response to vascular injury of the coronary and femoral arteries using a canine model. Both incorporation of 5-bromo-2'-deoxyuridine (BrdU) and neointimal formation after balloon injury were significantly greater in the coronary artery than in the femoral artery. Also, the proliferative and migratory activities of coronary smooth muscle cells (SMCs) were significantly greater than those of femoral SMCs in vitro. The level of phosphorylated myosin light chain (phospho-MLC) was higher in coronary SMCs than in femoral SMCs. Y-27632, a specific inhibitor of Rho-kinase, significantly inhibited the PDGF-induced migration of both coronary and femoral SMCs. In contrast, the migration of coronary SMCs, but not femoral SMCs, was inhibited by ML-9, a specific inhibitor of myosin light chain kinase (MLCK). These findings suggest that the contribution of Rho-kinase and MLCK differs between the different arteries. They also suggest that a neointima develops more easily in the coronary artery than in the femoral artery because of the greater proliferative and migratory activity of coronary SMCs. Differential activation of MLC might partly explain the increased proliferation and migration of coronary SMCs.     

Percutaneous transluminal angioplasty via dorsalis pedis artery for chronic total occlusion of superficial femoral artery: a case report

A 60-year-old woman with intermittent claudication underwent angiography, which showed total occlusion of the left superficial femoral artery and no distal flow. Computed tomography with contrast medium revealed that the occlusion extended to the popliteal artery but distal flow was maintained to the dorsalis pedis artery. Percutaneous transluminal angioplasty was attempted via the right femoral artery, but the guidewire could not be advanced. Therefore, a 4F sheath was inserted into the dorsalis pedis artery and the guidewire was passed through the occluded lesion. After pre-dilation, the guidewire was re-crossed from the right femoral artery and two stents were successfully implanted. Finally sufficient antegrade blood flow was achieved after the procedure. The trans-dorsalis pedis artery approach is a valuable option for the percutaneous transluminal angioplasty of long superficial femoral artery occlusion if the antegrade approach is impossible.     

The brachial artery method to transluminal coronary angioplasty

The development of a brachial artery guiding catheter for (percutaneous) trans-luminal coronary angioplasty is described. Three-hundred angioplasty procedures were attempted with 196 (65%) via the branchial and 104 (35%) via the femoral artery. The coronary stenosis was crossed in 202 attempts (67%); in 138 via the brachial (70%) and 64 via the femoral artery (62%). A successful angioplasty occurred in 117 via the brachial (85%) and in 50 via the femoral artery (78%). Successful angioplasty of the left anterior descending artery was equally effective with either technique. Successful angioplasty of the right coronary artery was more difficult (P < 0.05) using the femoral artery. An unsuccessful angioplasty with one technique was occasionally overcome by use of the other technique. No brachial artery complications were encountered. The brachial method to transluminal coronary angioplasty is an acceptable and complementary alternative to the femoral technique. Those laboratories contemplating percutaneous transluminal coronary angioplasty may desire to utilize both approaches.     

Complications with femoral access in cardiac cathetization. Impact of previous systematic femoral angiography and hemostasis with VasoSeal-ES collagen plug

INTRODUCTION AND OBJECTIVES: Most cardiac catheterizations are performed via femoral artery access, and hemostatic devices are commonly used. We evaluate the relationship between the strategy used for femoral arteriography and the use of VasoSeal-ES, and local vascular complications. PATIENTS AND METHOD: Prospective study of 540 consecutive catheterizations with systematic femoral artery and sheath angiography. VasoSeal-ES was used in 427 patients. Predictors of local vascular complications such as patient-related factors, anatomy and hemostasis were analyzed. Variables related to failure of the collagen plug were also studied. RESULTS: Punctures of the common femoral artery occurred in 35.9% of all patients (16% in the deep femoral artery and its ostium). Spasm was evident in 18% (ranging from 58.1% in the deep femoral artery to 5.2% in the common femoral artery). Puncture at the site of ramification was seen in 11.3%. Angiographically significant atheroma was seen in 17.8%. The femoral head was a valid landmark for the common femoral artery in only 63.9% of the pateints. Risk factors for local vascular complications were punctures of the common femoral artery, female sex and failure of VasoSeal-ES to achieve hemostasis (15.8% in the first two months of use, 5.2% in the last months of the study). Complications involving superficial and deep femoral arteries occurred in 6.7% and 1.2% of the patients, respectively, in contrast to 0.6% involving the common femoral artery. Variables related to collagen plug failure were patient-related factors, weight less than 55 kg, operator-related factors and the learning curve. CONCLUSIONS: Systematic femoral angiography provides data that aids the choice of the best hemostasis procedure to reduce local vascular complications. Punctures of the common femoral artery were more frequent than expected, and were associated with a higher complication rate. VasoSeal-ES is a safe and useful method of hemostasis, and its infrequent failures were associated with high complication rates that were substantially reduced with experience.     

Principles of surgery of the deep femoral artery in arteritis of the lower extremities]

The role of the deep femoral artery has too often been ignored in the assessment of arteritis of the lower limb. This anatomical distribution, which seems to be restricted to the thig, has left pride of place to the superficial artery as being responsible for intermittent claudication. In fact the deep femoral artery represents an exceptional and privileged route for anastomosis that is capable of replacing almost perfectly an obstructed superficial femoral artery and also in a more limited way femoro-popliteal arteries with extensive obstructions. The authors estimate that the deep femoral artery represents a true physiological bypass for a thrombosed superficial femoral artery on which a lumbar sympathectomy has a particularly remarkable action. It is important, in order to obtain as good a result as possible, that the flow in the deep femoral artery should be good, which presupposes complete freedom of the iliac axis and good permeability of the trunk of the artery, begining at its ostium. Surgery of the deep femoral artery is short or lon angioplastic surgery depending on the type of lesion, usually involving a venous patch. The surgical approach is straightforward. Whe it is used for isolated lesions or as the last stage of aorto-iliac surgery, delicate angioplasty of the deep femoral artery is a perfectly feasible operation which the authors believe should take its place, in association with lumbar sympathectomy, in the restoration of the superficial femoral artery.     

一种穿刺置管新方法在ECMO联合IABP介入治疗复杂高危冠心病中的应用

目的 评估应用同侧股动脉置入主动脉内球囊反搏（IABP）和大直径经皮冠状动脉介入（PCI）治疗指引导管,联合对侧股动脉与股静脉用于置入体外膜肺氧合（ECMO）的穿刺策略,观察该置管方式对于复杂高危冠心病患者（CHIP）完成PCI手术的安全性和可行性。 方法 共纳入7例患者,左侧股动脉与股静脉置入ECMO鞘管（动脉置管直径15F,静脉置管直径17F）,右侧股浅动脉置入IABP（均为7F动脉鞘管）,右侧股总动脉置入PCI股动脉鞘管（均为7F动脉鞘管）,ECMO动脉及静脉穿刺处采用预置ProGlide血管缝合器止血,PCI和IABP股动脉穿刺处应用Angioseal血管封堵器止血。术后针对股动脉、股静脉穿刺部位进行临床症状与体征评估,并全部进行血管超声检查,观察该穿刺置管的成功率以及完成PCI手术的可行性,观察住院期间穿刺部位相关的并发症发生率。 结果 7例患者中,男性6例,女性1例,年龄（57±12）岁,合并高血压5例（71%）、糖尿病3例（43%）、慢性肾病1例（14%）、高脂血症4例（57%）、卒中1例（14%）、外周血管疾病4例（57%）。双侧股动脉,左侧股静脉穿刺成功率100%,PCI手术完成率100%。仅一例患者术后超声检查发现股浅动脉穿刺部位发生皮下小血肿,所有患者住院期间均未观察到严重血管并发症。 结论 在CHIP患者中,当需要ECMO联合IABP维持血流动力学稳定,并需要穿刺股动脉置入大直径指引导管完成复杂PCI手术的情况下,可采用同侧股浅动脉置入IABP,股总动脉置入大直径（7F）PCI动脉鞘管,对侧股动脉、股静脉置入ECMO的手术穿刺策略,该方法安全可行。     

复合手术治疗复杂下肢动脉硬化闭塞症的疗效评估

目的 探讨复合手术治疗多节段复杂下肢动脉硬化闭塞症（arteriosclerosis obliterans,ASO）的临床疗效.方法 回顾性分析2009年1月-2012年12月采用复合手术治疗多节段复杂下肢ASO的47例患者（均为单肢症状）.其中男性37例,女性10例.股动脉内膜切除补片成形＋逆向长段髂动脉内膜剥脱＋ stent/PTA 7例,股动脉内膜切除补片成形＋ stent/PTA（顺行、逆行）17例,股动脉内膜切除补片成形＋顺行长段股浅动脉内膜切除＋stent/PTA8例,股动脉内膜切除补片成形＋髂动脉stent/PTA＋股深动脉成形术5例,髂动脉stent＋股-股动脉人工血管移植术2例,股动脉切开取栓＋内膜剥脱补片成形/stent/PTA 8例,合并膝下动脉病变,部分予以小球囊局段扩张.以上补片为涤纶,人工血管材料为PTFE.结果 手术成功率100％,无严重并发症,踝肱指数（ankle brachial index,ABI）由术前（0.30±0.19）提高至术后（0.63 ±0.20）,下肢症状均不同程度改善,术后平均随访1年,通畅率87.2％ （41/47）,4例坏疽足趾自行脱落,6例股浅动脉支架内再狭窄.结论 复合手术（股动脉内膜切除结合腔内技术）治疗FontaineⅡ-Ⅳ期多节段复杂下肢动脉硬化闭塞症简洁微创、安全有效、中远期疗效可,尤其适合老年危重患者.