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。

Hybrid therapy for complex lower limbs multi-segment ASO

Objective：To discuss the clinical effect of hybrid（combined surgical-endovageular） therapy for complex arteriosclerosis obliterans（ASO）.Methods：From January,2009 to June,2010,21 ASO cases were treated hybrid therapy.The procedures were as follow as：common femoral arteriotomy（CFA）,iliac artery embolectomy of Fogarty catheter ＋ iliac PTA ＋ STENT in 2 cases,iliac artery PTA ＋ STENT ＋ common femoral artery endarterectomy（TEA） in 4 cases,iliac artery PTA ＋ STENT ＋ common femoral TEA ＋ femoral artery embolectomy of Fogarty in 1 case,iliac artery PTA ＋ STENT ＋ common femoral artery TEA ＋ femorpopliteal bypass in 1 case,iliac artery PTA ＋ STENT ＋ common femoral artery TEA ＋ superficial femoral artery PTA ＋ STENT in 2 cases,iliac artery PTA ＋ STENT ＋ common femoral artery TEA ＋ infrapopliteal artery PTA in 2 cases,iliac artery PTA ＋ STENT ＋ common femoral artery TEA ＋ femoral profound artery angioplasty expansion in 2 ases,common femoral ＋ superficial femoral artery TEA ＋ superficial femoral artery PTA ＋ STENT in 3 cases,superficial femoral artery TEA ＋ infrapopliteal artery PTA ＋ popliteal artery PTA ＋ infrapopliteal artery PTA in 3 cases,infrapopliteal artery PTA and then femorpopliteal bypass in 1 case.Results：The technical succsess rate was 100%.The ankle brachial Index（ABI）was improved markedly from 0.31 preoperatively 0.66 postoperatively,All cases received clinical assessment and color Doppler ultrasonography exam at 3,6,9 and 12 months after the operation.One case died of acute myocardial infarction 11 months after treatment.2 cases were found restenosis.The patency rate was 90%.Conclusion：hybrid therapy is a safe and mini-traumatic treatment for complex ASO with high long-term patency rate.