盐酸沙格雷酯在腹主动脉瘤腔内修复术后防治臀肌和下肢缺血的初步观察

目的观察盐酸沙格雷酯在腹主动脉瘤腔内修复术后防治臀肌和下肢缺血的作用。方法回顾性收集我院血管外科2006年1月至2011年1月期间收治的腹主动脉瘤行腔内修复术(EVAR)治疗的患者174例,年龄(71.8±8.2)岁,其中男148例,女26例。腹主动脉瘤直径(55.2±12.9)mm,累及髂总动脉52例(29.9%)。EVAR治疗方法包括置入分叉型人工血管支架169例(97.1%),单臂型5例(2.9%)。其中术中封闭单侧髂内动脉29例,封闭双侧髂内动脉10例,术后均口服盐酸沙格雷酯100 mg,3次/d,阿司匹林100 mg,1次/d 2～4周。随访观察术后患者臀肌和下肢发生缺血情况。结果全部病例行EVAR术顺利,无中转开腹;行全身麻醉88例(50.6%),硬膜外阻滞麻醉52例(29.9%),局部麻醉34例(19.5%);术中失血量为(125.2±43.1)ml,术中无输血,手术时间为(145.5±38.7)min;术后ICU观察时间和禁食时间分别为(14.7±5.2)h和(7.2±4.3)h;术后平均住院时间为(9.1±2.7)d。围手术期并发症发生率为12.6%(22/174),术后30 d死亡率为1.1%(2/174)。术中封闭单侧髂内动脉29例中2例出现同侧臀肌轻度疼痛,行走疼痛加重,跛行距离100 m,5例出现同侧下肢乏力,间歇性跛行距离100～200 m;封闭双侧髂内动脉10例中4例术后出现臀肌轻度疼痛,跛行距离200 m,均采用口服盐酸沙格雷酯和阿司匹林扩血管、祛聚治疗后2～4周好转,间歇性跛行距离均大于500 m,无臀肌坏死发生,无再行介入或外科干预治疗,中位随访时间16.1个月,未诉特殊不适。结论盐酸沙格雷酯在EVAR术后防治臀肌和下肢缺血疗效满意,尤其适合于封闭双侧或一侧髂内动脉和合并下肢动脉硬化闭塞者。

Premilinary Observation of Sarpogrelate Hydrochloride on Prevention and Treatment for Gluteal and Limb Ischemia Following Endovascular Repair of Abdominal Aortic Aneurysm

Objective To observe the effects of sarpogrelate hydrochloride in prevention and treatment for ischemia of gluteal and limb following endovascular repair of abdominal aortic aneurysm(EVAR).Methods Clinical data were analyzed in 174 patients with abdominal aortic aneurysm(AAA) who underwent EVAR from January 2006 to January 2011.The patients’ mean age was(71.8±8.2)years old(male: 148 cases,female: 26 cases).The diameter of abdominal aortic aneurysm was(55.2±12.9) mm.AAA involving common iliac artery was in 52(29.9%) patients.Bifurcated endografts and aorto-uni-iliac(AUI) endografts with crossover bypass were used in 169 patients(97.1%) and 5 patients(2.9%),respectively.Sarpogrelate hydrochloride were used in 39 patients with gluteal and limb ischemia due to exclusion of bilateral and unilateral internal iliac arteries among 174 patients.Sarpogrelate hydrochloride,100 mg,three times daily,was taken for 2-4 weeks.Symptoms of gluteal and limb ischemia were followed-up. Results All of patients with AAA was repaired by EVAR successfully and no conversion to open repair.General anesthesia(50.6%(88/174)),epidural anesthesia(30.0%(52/174)),and local anesthesia(19.5%(34/174)) were used.Blood loss was(125.2±43.1) ml and no blood transfusion during operation.Operative time was(145.5±38.7) min,ICU stay time was(14.7±5.2) h,and postoperative fasting time was(7.2±4.3) h.The duration of postoperative hospital stay was(9.1±2.7) d.The perioperative complication rate was 12.6%(22/174).The 30-day mortality rate was 1.1%(2/174).Gluteal and limb claudication occurred in 2 paients and 5 patients respectively among 29 patients with EVAR due to exclusion of unilateral internal iliac artery,intermittent claudication distance was 100-200 meters.Gluteal muscle pain and limb claudication for less than 200 meters occurred in 4 patients due to exclusion of bilateral internal iliac artery.The symptoms were relieved after Sarpogrelate hydrochloride,100 mg,three times daily,was taken for 2-4 weeks.No gluteal gangrene occurred and claudication distances were more than 500 meters when walking,no any interventional and surgical procedures were required,all of them were doing well for median 16.1 months follow-up period.Conclusions Sarpogrelate hydrochloride has definite effects on prevention and treatment for gluteal and limb ischemia following endovascular repair of abdominal aortic aneurysm,especially for exclusion of bilateral and unilateral internal iliac arteries during EVAR