TAGC C、D级髂动脉病变的腔内治疗

目的 探讨腔内技术治疗TASC C、D级髂动脉病变的可行性及近期疗效.方法 回顾性总结77例TASCC、D级(共89条髂动脉)行腔内治疗患者的临床资料;其中TASC C级病变63例,TASC D级病变14例.结果 3条髂动脉未能开通闭塞段,开通率为96.6%.23条髂动脉行单纯经皮血管腔内成形术治疗,其余63条髂动脉置人支架.共置入支架104枚.踝肱指数由术前0.20±0.14增至术后7天的0.71±0.21(P=0.02).主要并发症发生率3.9%.64例(78条髂动脉)患者获得随访,随访率83.1%;平均随访时间23(6-53)个月,其1、2、4年肢体通畅率分别为88%、84%和70%.结论 腔内治疗TASC C、D级髂动脉病变安全微创,其短期效果较好.     

TASC-Ⅱ C/DC/D级髂动脉闭塞的腔内治疗

目的探讨对泛大西洋协作组织(TASC)-ⅡC/D级髂动脉闭塞患者采用腔内治疗的疗效。方法回顾性分析我院血管外科2012年3月至2014年3月期间收治的25例TASC-ⅡC/D级髂动脉闭塞(共28条髂动脉,其中TASC-ⅡC级病变19条,TASC-ⅡD级病变9条)患者行腔内治疗的临床资料。结果 2条髂动脉闭塞未能开通,开通率为92.86%;其余26条髂动脉均行球囊扩张、支架置入术。踝肱指数由术前的0.23±0.18增至术后的0.76±0.19(P0.05)。2例穿刺处血肿,经保守治疗好转;1例出现支架内血栓,经置管溶栓后通畅。20例患者24条髂动脉获得随访,随访率为85.71%。随访时间3~24个月,平均8个月,其6个月、1年、2年累积一期通畅率分别为85%、80%、73%。结论 TASC-ⅡC/D级髂动脉闭塞腔内治疗的近期疗效好,创伤小,并发症少。     

股腘动脉粥样硬化病变腔内治疗的疗效分析

目的评价股腘动脉硬化病变腔内治疗的近期临床疗效。方法回顾性分析2008年1月～2009年6月收治的55例(57条患肢)TASCC型股腘动脉病变患者的临床资料,其中50例(52条患肢)施行经皮血管腔内球囊成形术和支架植入术,应用踝/肱指数(ABI)、Fontaine分期、保肢率和通畅率综合评估治疗效果。结果腔内治疗技术成功率91.2%,围手术期死亡率5.3%,截肢率3.5%。腔内治疗明显提高患肢足背动脉AB(I0.38±0.17vs0.68±0.39,P0.01)和胫后动脉的AB(I0.41±0.18vs0.72±0.50,P0.05)。重症下肢缺血(CLI)的患肢数由治疗前的36条(63.2%)减少至治疗后的19条(36.5%),差异具有统计学意义(P0.01)。平均随访(11.4±6.4)个月,随访期足背动脉和胫后动脉ABI分别为0.48±0.38和0.61±0.47,与术前和术后相比,差异均有统计学意义(P0.05);随访期CLI的患肢数(12条,29.3%)与治疗前(36条,63.2%)比较,差异有统计学意义(P0.05),与治疗后(19条,36.5%)比较,差异无统计学意义(P0.05)。结论腔内治疗TASCC型股腘动脉硬化病变创伤小,近期临床疗效满意。     

腔内血管成形术治疗髂动脉长段慢性完全闭塞性病变

目的 评价腔内血管成形术治疗髂动脉长段慢性完全闭塞性病变(CTO)的可行性、有效性及安全性.方法 回顾性分析2006年1月至2010年12月经腔内血管成形术治疗的病变长度＞5 cm的髂动脉CTO患者139例(157条患肢)的临床资料.其中男性93例(105条患肢),女性46例(52条患肢);年龄50 ～96岁,平均年龄(77±10)岁.TASCⅡ分型:B型18例,C型89例,D型32例.采用左肱动脉和(或)股动脉穿刺经内膜下或血管内行髂动脉闭塞的球囊血管成形联合支架植入术治疗.结果 技术成功率96.2％ (151/157).踝肱指数由术前的0.42±0.19上升到术后的0.81±0.26.随访6～53个月,平均随访(30±7)个月,髂动脉支架畅通率94.1％ (111/118),7例发生支架内再狭窄或闭塞,无髂动脉破裂、支架移位、穿刺动脉假性动脉瘤及动静脉瘘的发生.结论 腔内血管成形术治疗髂动脉长段CTO安全、有效,术后支架通畅率高,联合肱动脉和股动脉双向穿刺技术能够显著提高技术成功率.     

血管腔内成形术治疗髂动脉硬化闭塞症

目的 探讨血管腔内成形术治疗髂动脉硬化闭塞症的临床疗效.方法 回顾性分析2002年12月至2008年12月收治的61例(76条血管)髂动脉硬化闭塞症患者的临床资料,其中男46例,女15例.平均年龄(67±11)岁.主要临床症状包括严重的间歇性跛行(跛行距离<100 m)38例,静息痛13例,肢/趾端溃疡10例.TASC A型病变29例,B型16例,C型11例,D型5例.应用导丝导管或超声消融开通闭塞段,行腔内支架置入术后随访.结果 61例患者71条血管成功开通(共置入63枚支架),开通率93%(71/76).成功者临床症状改善率100%.踝肱指数(ABI)由术前0.33±0.17提高到术后0.72±0.20,差异有统计学意义(P<0.05).随访51例,随访率83%.随访时间6-60个月,平均(26±14)个月.1年通畅率90%(TASC A、B组92%;TASC C、D组84%).3年通畅率75%(TASC A、B组80%;TASC C、D组63%);5年通畅率72%.结论 髂动脉硬化闭塞的腔内成形术较传统的血管重建手术创伤小、并发症低,近、中期通畅率相当.     

腔内支架治疗泛大西洋协作组(TASC)Ⅱ C、D级股动脉病变

目的探讨腔内支架置入治疗泛大西洋协作组(TransAtlantic Inter-Society Consensus,TASC)ⅡC、D级股动脉病变的可行性及近期疗效。方法 2008年1月～2010年12月,对24例患者(共27条股动脉,C级21条,D级6条)进行腔内治疗,开通成功后应用球囊扩张闭塞段并置入自膨式支架。结果成功开通25条股动脉,开通率92.6%(25/27),2条股动脉因病程较长、病变段钙化严重未能开通而行开放外科旁路术。25条股动脉共置入支架62枚。6条患肢的间歇性跛行距离由术前的61 m(30～150 m)增加至术后7天的560 m(300～950 m)(t=3.54,P=0.018)。12条患肢的疼痛消失,5条患肢疼痛可忍受,2条患肢疼痛偶尔需口服止痛药物缓解。所有患肢皮肤颜色变红润,腘动脉、足背和(或)胫后动脉搏动明确。踝肱指数由术前0.36±0.12增至术后7天的0.78±0.25(t=2.16,P=0.038)。19例(21条股动脉)随访4～25个月(平均9.8月):4例各有1条股动脉分别于术后7、11、12和15个月时出现支架内狭窄及血栓形成,其中3例经导管溶栓和球囊扩张后症状缓解,另1例行股腘动脉旁路术后症状缓解,其余15例(17条患肢)均无缺血症状加重表现。结论腔内支架治疗TASCⅡC、D级股动脉病变具有安全和微创的优点,短期效果良好。     

药物球囊在股腘动脉支架内再狭窄中运用的中期随访结果北大核心CSCD

目的评价紫杉醇药物涂层球囊(drug-coated balloon,DCB)在股腘动脉支架内再狭窄(in-stent restenosis,ISR)血管腔内治疗中的临床效果。方法对2016年12月至2020年7月接受DCB治疗的股腘动脉ISR患者进行回顾性分析。评价腔内操作的围手术期并发症发生率,术后12、18个月靶血管一期通畅率、一期辅助通畅率、二期通畅率、免于临床症状驱动的靶病变血运重建率(free from clinically-driven target lesion revascularization,F-TLR)、大截肢率以及全因死亡率。结果共52例ISR患者(56条下肢)接受了DCB治疗。根据Rutherford分级:2级1例(1.7%),3级9例(23.2%),4级23例(41.1%),5级15例(26.8%),6级4例(7.1%)。Tosaka Ⅱ级ISR 46条下肢(82.1%),Ⅲ级ISR 10条下肢(17.9%)。平均ISR长度(240±122)mm。一期补救性支架植入率25%。中位随访时间18个月。全因死亡率11.8%、大截肢率为5.9%、一期通畅率53.4%、一期辅助通畅率67.1%、二期通畅率93.2%、F-TLR为77.2%。结论 DCB是一种安全有效的股腘动脉ISR血管腔内治疗手段。     

动脉自膨式支架置入治疗下肢缺血

目的探讨下肢各个部位动脉腔内自膨式支架置入治疗下肢缺血的疗效。方法对2002年1月-2006年3月支架治疗65例71条患肢的临床资料进行临床回顾性研究，其中52．3％（38／71）肢体为糖尿病下肢动脉硬化，47、7％（33／71）肢体为非糖尿病下肢动脉硬化。支架部位包括腹主动脉支架2例2条患肢2枚支架，腹主动脉及髂动脉闭塞行腹主动脉和单侧髂动脉支架置入1例3枚支架，髂动脉支架33例35条患肢38枚支架，髂动脉和股浅动脉同时支架置入6例6条息肢12枚支架，股浅动脉支架置入16例19条肢体23枚支架，股浅动脉和近端胭动脉病变同时支架置入5例6条患肢10枚支架，远端胭动脉支架2例2条患肢。结果65例随访2—50个月，平均16．1月，2例腹主动脉支架、1例腹主动脉与髂动脉支架同时置入全部通畅；髂动脉支架闭塞4例4条患肢，通畅率88．6％（31／35）；股浅动脉支架闭塞4例4条患肢，通畅率为78．9％（15／19）；股浅动脉与近端胭动脉支架闭塞1例，通畅率83．3％（5／6）；远端胭动脉支架2例全部闭塞；3例小腿动脉流出道主干动脉全部闭塞的支架术后平均5．6月仍然保持通畅。结论下肢动脉腔内支架置入可作为治疗主髂动脉病变的首选方法；对于股动脉和近段胭动脉病变也可根据情况适当选用，尤其是年老体弱，无法耐受动脉旁路移植手术的患者，也可以作为首选方法；对于膝下小动脉病变应慎重使用支架。     

严重肢体缺血的股腘动脉TASC C/D级病变的腔内治疗

目的 评估腔内治疗股腘动脉TASC C/D级病变导致的严重症肢体缺血的疗效.方法　回顾性分析2009年1月至2012年1月因泛大西洋协作组(TASC)ⅡC和D级股腘动脉闭塞导致下肢严重缺血87例患者接受血管腔内治疗结果,男58例,女38例,平均年龄(76±10)岁.Rutherford 4期68条肢体,5期23条肢体,6期5条肢体.统计手术前后踝肱指数(ABI),术后靶血管通畅率,保肢率.结果 87例患者(共96条肢体)接受血管腔内治疗,技术成功率94.80％,单纯行球囊扩张13条肢体,支架植入80条肢体,导管溶栓辅助球囊扩张和支架术8条肢体,跨膝关节支架47条肢体.围手术期主要并发症发生率为19.08％,死亡2例.术前ABI平均为0.25±0.17,术后ABI为0.76±0.23.所有患者均获得随访,平均随访(12±6)个月.术后1个月靶血管通畅率为94.79％,3个月为93.73％,6个月为88.01％,12个月78.34％,24个月为68.38％.术后1个月肢体救治率为95.83％、3个月为95.83％,6个月为93.42％,12个月93.42％,24个月为83.04％.结论 股腘动脉TASC C/D病变导致严重缺血患者腔内治疗的并发症发生率和再狭窄率较高,但近期肢体救治效果良好.     

近肾主髂动脉闭塞病变腔内治疗的疗效评价

目的探讨近肾主髂动脉闭塞病变(AIOD)患者腔内治疗的安全性及疗效。方法回顾性分析辽宁省人民医院2005年1月至2015年6月17例接受腔内治疗的近肾AIOD患者的临床资料。按Rutherford分级:4级5例,5级9例,6级3例。患者均采用腔内治疗,经股动脉和肱动脉入路,采用球囊扩张、支架植入及保护伞保护内脏动脉,开通病变血管后行球囊扩张和支架植入。结果手术成功率为88.23%。7例患者肾动脉造影后出现狭窄或夹层,其中5例患者植入覆膜支架、1例植入金属裸支架及1例行主髂动脉开窗技术后显影通畅。15例(88.23%)患者临床症状明显改善,术后平均踝肱指数为0.92±0.22,明显高于术前(0.35±0.08),手术前后比较差异有统计学意义(P0.01)。术后随访5~58个月,平均随访时间(25.6±12.4)个月,术后1年、3年一期通畅率分别为88.2%及82.4%,总体生存率分别为94.1%及82.4%,二期通畅率为100%。2例患者随访期间出现肾动脉再狭窄,经肾动脉球囊扩张后血流通畅。结论对于开放手术高危的近肾AIOD病变患者,腔内治疗不失为一项安全有效的治疗手段,可获得较满意的临床疗效和早中期通畅率。     

TASC-C��D���������Ķ���Ӳ���Ա���ǻ�ڽ�������14������

目的探讨TASC-C、D型慢性主髂动脉病变腔内介入治疗的操作成功率、安全性和近期通畅率。方法2005年4月至2006年12月,上海交通大学医学院附属仁济医院血管外科采用血管腔内介入方法治疗TASC-C、D型慢性主髂动脉病变病人14例,其中2例接受了二期远端流出道重建。结果无围手术期死亡。血管腔内介入治疗成功率为93.7%,并发症发生率为7.1%。随访2~20个月(平均6.5个月),病人症状无加重或复发。结论血管腔内介入治疗TASC-C、D型慢性主髂动脉病变具有较高的操作成功率,围手术期并发症少,近期效果确切,其长期疗效尚须进一步随访观察。     

TASCⅡ C、D型股腘动脉闭塞腔内治疗的操作技巧与疗效分析

目的观察TASCⅡ C、D型股腘动脉闭塞腔内治疗的临床疗效,分析影响治疗效果的可能因素与操作技巧。方法 2009年1月～2010年6月,89例(113条患肢)TASCⅡ C、D型股腘动脉闭塞患者接受腔内治疗。对患者术后3、6和12个月时的临床症状、踝肱指数(ABI)、并发症发生率和累计通畅率进行分析。结果成功开通病变肢体共106条,技术成功率93.8%。36条(34.0%)患肢出现并发症。75例患者(共92条下肢)获得随访,随访率为86.8%。平均随访时间12.5个月。术后3、6和12个月时的平均ABI分别为0.74±0.39、0.68±0.38和0.66±0.31,与术前比较(0.43±0.39),差异均有统计学意义(P<0.01)。术后12个月的一期通畅率、辅助通畅率和二期通畅率分别为64.6%、72.4%和81.5%。结论 TASCⅡ C、D型股腘动脉闭塞腔内治疗是一种安全有效的方法。熟练的腔内操作技术和规范的术后指导是提高技术成功率和维持动脉早中期通畅的关键。     

TASC-D型髂动脉病变的腔内治疗

目的 探讨对泛大西洋协作组织(TransAtlantic Inter-Society Consensus Working Group,TASC)-D型髂动脉闭塞性病变腔内治疗的疗效.方法 回顾性分析自2006年6月至2010年6月,TASC-D型髂动脉病变腔内治疗的26例患者(共31条肢体)的临床资料.单纯髂动脉病变10例,髂动脉合并腹股沟以下病变16例.结果 24例患者(28条肢体)获得成功,技术成功率90.3%(28条/31条),成功的28条肢体临床症状改善率100%(28条/28条),治疗成功者共放置支架44枚,其中8条肢体进行腹股沟以下动脉腔内治疗,3条肢体同时行股-腘人工血管旁路术,8例患者辅助超声消融技术.术后踝-肱指数(ankle-brachial index,ABI)为0.67±0.16,较术前0.37 ±0.15提高,两者差异有统计学意义(t=13.24,P<0.01).随访22例(26条肢体),时间3～44个月,平均(22±11)个月.1年初期通畅率90%(18/20);二期累积通畅率95%(19/20);3年初期通畅率70%(7/10),二期累积通畅率80%(8/10).结论 对于难以耐受外科手术的TASC-D型髂动脉病变可以选用腔内治疗.

Abstract：

Objective To evaluate recanalization for TASC-D type iliac artery lesions.Methods Between June 2006 and June 2010,26 patients with a total of 31 limbs of the TASC-D iliac artery lesions underwent endovascular procedure. Results Technical success rate was 90.3% (28/31).Clinical symptom improvement rate was 100%. Forty-four stents were placed in 28 limbs of the 24 patients.Eleven patients underwent an associated procedure; femoropopliteal endovascular procedures in 8 cases,femoro-popliteal bypass in 3 cases. Eight patients underwent an intravascular ultrasound thrombolysis.Postoperative ankle-brachial index ( ABI) was increased by more than 0. 15 in all patients. Twenty-two patients(26 limbs) were followed-up for 3 -44 mos, the primary patency rate at 12 months was 90% ,and cumulative patency rate was 95%. At 36 months primary patency rate was 70% , and secondary patency rate was 80%. Conclusions Because the technical success rate is high, endovascular techeniques are the choice of therapy in high risk patients with TASC-D type iliac artery lesions.     

Endovascular management of iliac artery occlusions: extending treatment to TransAtlantic Inter-Society Consensus class C and D patients

OBJECTIVE: The preferential use of endovascular techniques to treat complex aortoiliac disease has increased in recent years. The purpose of this study was to review the outcomes and durability of recanalization, percutaneous transluminal angioplasty, and stenting for iliac occlusions based on the patient's TransAtlantic Inter-Society Consensus (TASC) stratification. METHODS: Between 1998 and 2004, more than 628 patients with a clinical diagnosis of aortoiliac atherosclerotic disease underwent arteriography. The endovascular treatment of 89 consecutive patients (mean age, 66 years; 58% male) with symptomatic iliac occlusions (TASC-B, -C, and -D) was the basis for this study. Original angiographic imaging was evaluated for lesion grade and runoff. Electronic and hard copy medical records were reviewed for demographic data, clinical variables, and noninvasive vascular laboratory testing. Kaplan-Meier estimators were used to determine patency rates according to Society for Vascular Surgery criteria. Univariate and multivariate analyses were performed. P values of <.05 were considered significant. RESULTS: Recanalization and percutaneous transluminal angioplasty/stenting (total, 178 stents) of occluded iliac arteries was technically successful in 84 (91%) of 92 procedures. Patients in the TASC-C and -D groups often required multiple access sites (50%) and femoral artery endarterectomy/patch angioplasty for diffuse disease (24%). The mean ankle-brachial index increased from 0.45 to 0.83. Distal embolization led to major amputation and eventual death in one patient. Two other deaths occurred in the perioperative period secondary to cardiorespiratory causes. Three-year primary patency, secondary patency, and limb salvage rates were 76%, 90%, and 97%, respectively, and progression of infrainguinal disease led to late limb loss in two patients. Diabetes as a risk factor was significantly associated with decreased primary patency (57% vs 83%; P = .049). Critical ischemia at presentation was associated with decreased patency rates as well (P = .002), but TASC classification did not significantly alter patency rates. CONCLUSIONS: Complex long-segment and bilateral iliac occlusions can be safely treated via endovascular means with high rates of symptom resolution. Initial technical success, low morbidity, and mid-term durability are comparable to results with open reconstruction. A liberal posture to open femoral artery reconstruction extends the ability to treat diffuse TASC-C and -D lesions via endovascular means.     

介入联合手术治疗长段髂动脉闭塞病变

目的探讨介入联合手术治疗长段髂动脉闭塞病变的近期治疗效果。方法回顾性分析2008年8月～2010年6月介入联合手术治疗11例（13条）长段髂动脉闭塞的临床资料。双侧髂动脉合并腹主动脉下段闭塞2例（4条）,髂动脉合并股总动脉闭塞6例,髂动脉合并多发股浅或腘动脉闭塞3例。对11例（13条）长段髂动脉闭塞病变行Fogarty球囊取栓联合球囊扩张成形支架植入,并进行门诊和电话随访。结果 13条髂股动脉均开通成功,下肢缺血症状出现或加重2个月内的7条患肢术中取出较多血栓。术后未出现伤口感染、血肿、肺炎、死亡,术后1周踝肱比（ABI）由术前的0.07±0.13提高至0.56±0.19,差异有显著性（t=8.517,P=0.000）。随访12～28个月,平均18个月,13条患肢均保存良好,髂动脉一期通畅。结论介入联合手术治疗长段髂动脉闭塞病变的近期效果良好,并发症发生率较低。介入联合手术治疗在患肢缺血症状突然出现或加重2个月内的髂动脉长段闭塞病变,以及髂动脉闭塞合并股总动脉闭塞病变的患者具有较大优势。     

Long-term outcomes and predictors of iliac angioplasty with selective stenting

OBJECTIVE: To review our 11-year experience of iliac angioplasty with selective stenting and to evaluate the safety, short- and long-term patency, clinical success rates, and predictive risk factors in patients with iliac artery occlusive disease. METHODS: From August 1993 to November 2004, 151 iliac lesions (149 stenoses, 2 occlusions) in 104 patients were treated by percutaneous transluminal angioplasty (PTA). The patients had chronic limb ischemia described as disabling claudication (the Society for Vascular Surgery clinical category 2 or 3) in 76 (50%), rest pain (category 4) in 38 (25%), and ulcer/gangrene (category 5) in 37 (25%). Forty-six limbs (30%) were treated with concomitant infrainguinal endovascular (36, 24%) or open procedures (10, 6%). Thirty-four limbs (23%) had one or more stents placed for primary PTA failure, including residual stenosis (> or =30%), mean pressure gradient (> or =5 mm Hg), or dissection (stent group); whereas, 117 limbs (77%) underwent PTA alone (PTA group). The affected arteries treated were 28 (19%) common iliac, 31 (20%) external iliac, and 92 (61%) both arteries. According to TransAtlantic Inter-Society Consensus (TASC) classification, 39 limbs (26%) were in type A, 71 (47%) in type B, 36 (24%) in type C, and 5 (3%) in type D. Reporting standards of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery were followed. RESULTS: There was no perioperative death. Total complication rate was 0.7% (one groin hematoma). The mean follow-up was 21 months (median, 10; range, 1 to 94 months). Only 9 (8%) of 117 of the PTA group had subsequent stent placement for recurrent stenosis. The iliac lesions were more severe and extensive in the stent group than those in the PTA group according to TASC classification (Mann-Whitney U test [M-W], P < .0001) and anatomic location (M-W, P = .0019). The technical success rate was 99%, and the initial clinical success rate was 99%. Overall, the cumulative primary patency rates at 1, 3, and 5 years were 76%, 59%, and 49% (Kaplan-Meier [K-M]). The cumulative assisted primary and secondary patency rates at 7 years were 98% and 99% (K-M). The mean number of subsequent iliac endovascular procedures was 1.4 per limb in patients with primary failure of iliac angioplasty/stenting. The continued clinical improvement rates at 1, 3, and 5 years were 81%, 67%, and 53% (K-M). The limb salvage rates at 7 year were 93% (K-M). Of 15 predictor variables studied in 151 iliac lesions, the significant independent predictors for adverse outcomes were smoking history (P = .0074), TASC type C/type D lesions (P = .0001), and stenotic ipsilateral superficial femoral artery (P = .0002) for the primary patency rates; chronic renal failure with hemodialysis (P = .014), ulcer/gangrene as an indication for PTA (P < .0001), and stenotic ipsilateral superficial femoral artery (P = .034) for the continued clinical improvement (K-M, log-rank test and Cox regression model). CONCLUSIONS: Although the primary patency rates were not high, the assisted primary and secondary patency rates were excellent without primary stenting. Overall, >70% of iliac lesions were treated successfully with PTA alone. The results of this study show that selective stenting offers satisfactory assisted primary and secondary long-term patency after iliac angioplasty. Patients with TASC type C/type D iliac lesions, a stenotic ipsilateral superficial femoral artery, ulcer/gangrene, smoking history, and chronic renal failure with hemodialysis should be followed carefully after endovascular iliac revascularization. These risk factors could be considered indications for primary stenting, although further studies are needed to confirm this.     

个体化血管重建术治疗下肢多平面动脉硬化闭塞症

目的 观察序贯立交搭桥或结合腔内技术治疗下肢多平面动脉硬化闭塞症的临床效果。方法 2004年4月～2005年7月，对11例14条下肢多平面动脉硬化闭塞症患者，采用序贯立交搭桥或动脉内膜剥脱术或腔内外结合手术治疗。其中男10例，女1例；年龄62～79岁，平均70．5岁。表现为间歇性跛行8例（FontaineⅡ期），静息痛3例（Fontaine Ⅲ期），足趾溃疡、坏疽1例（FontaineⅣ期）。彩色多普勒检查示14条下肢均为多平面动脉硬化闭塞，踝肱指数（ankle brachialindex，ABI）为0．36±0．11。下肢数字减影血管造影（digital subtraction angiography，DSA）显示双侧髂总动脉闭塞2em、髂外动脉闭塞、双侧股浅动脉闭塞3例，右侧髂总动脉狭窄、髂外动脉闭塞、双侧股浅动脉闭塞1例，单侧髂外动脉狭窄、股浅动脉闭塞7例。术后行DSA、彩色多普勒检查及ABI测定，观察血管通畅情况。结果 术后无死亡。患者均获随访3～26个月，平均14．5个月。间歇性跛行、静息痛等症状均消失，ABI术后为0．89±0．13，与术前比较差异有统计学意义（P〈0．01）。肢体获救率100％。术后3～280d行下肢DSA显示转流血管通畅率为92．86％（13／14）。结论 序贯立交搭桥或腔内外手术结合，是治疗严重下肢多平面动脉硬化闭塞症的一种可靠、安全、相对微创的治疗方法。     

腔内双向开通慢性髂动脉闭塞的长期结果分析

目的分析腔内治疗时经双向开通的复杂髂动脉闭塞患者的长期通畅率。方法回顾性分析首都医科大学附属北京世纪坛医院2012年8月至2018年8月因慢性髂动脉闭塞尝试双向开通并且最终成功完成腔内手术的58例患者(66条肢体)资料,统计长期通畅率。结果技术成功率96.6%。1年的一期通畅率96.6%(56/58),5年一期通畅率82.6%(19/23),二期通畅率91.3%(21/23),主要不良事件率为8.7%(2/23)。结论腔内双向开通复杂髂动脉闭塞性病变,有创伤小、恢复快等优点,而且其长期通畅率并不劣于开放手术。