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。

INDIVIDUAL REVASCULARIZATION FOR TREATMENT OF MULTILEVEL ARTERIAL OCCLUSIVE DISEASE OF LOWER EXTREMITY

OBJECTIVE: To determine the clinical effect of sequence and cross bypass or combined with endovascular procedure for mutilevel arterial occlusive disease of lower extremity so as to investigate the credible treatment for mutilevel arterial occlusive disease of lower extremity. METHODS: Between April 2004 and July 2005, 11 patients (14 limbs)underwent sequence and cross bypass, thromboendarterectomy or combined with endovascular procedure. Among of them, 10 cases were male and 1 case was female, aging 62-79 years(mean 70. 5 years), and including 8 cases of intermittent claudications (Fontaine stage II), 3 cases of rest pain (Fontaine stage III) and 1 case of toe ulcer with gangrene (Fontaine stage IV). Colour Doppler ultrasonography showed that 14 lower limbs were diagnosed as having multilevel arterial occlusive disease and the preoperation and ankle brachial index (ABI) was 0.36 +/- 0. 11 . Lower limb digital subtraction angiography (DSA) showed 3 cases of bilateral iliac artery stenosis, extrailiac artery occlusion and bilateral superficial femoral artery occlusions, 1 case of right common iliac artery stenosis, extrailiac artery occlusion and bilateral superficial femoral artery occlusions and 8 cases of unilateral extrailiac artery stenosis and superficial femoral artery occlusions. Postoperation tests of DSA,colour Doppler ultrasonography and ABI were done to observe cumulative patency rate after operation. RESULTS: The follow-up period was from 3 to 26 months (mean 14.5 months ). All patients survived. The symptoms of intermittent claudication and rest pain disappeard in all patients. ABI was improved by 0.89 +/- 0.13 after procedure (P < 0.01). The overall salvage rate of limb was 100%. DSA was performed from 3 to 280 days after operation, the overall primary graft patency rate was 92.86% (13/14). CONCLUSION: Sequence and cross bypass, thromboendarterectomy or combined with endovascular procedure in treatment of mutilevel occlusive disease of lower extremity was effective, less invasive and safe.