血管腔内治疗联合外科手术治疗下肢动脉硬化闭塞症

目的 评价血管腔内治疗联合外科手术治疗多节段性下肢动脉硬化闭塞症的效果.方法 对32例多节段性下肢动脉硬化闭塞症患者施行髂动脉球囊扩张及支架植入等血管腔内治疗方法开通髂血管,择期再对股胭段病变行自体大隐静脉或人工血管旁路转流术.结果 32例患者手术过程均成功,术后下肢缺血症状改善,表现为间歇性跛行消失或跛行距离明显增大,静息痛好转,肢体溃疡愈合.术后平均踝肱指数为0.65±0.18,与术前(0.28±0.14)相比有明显提高(P<0.05).术后随访30例,随访时间3～36个月.平均18个月.支架植入后髂动脉均通畅;有2例行旁路转流术患者出现吻合口狭窄,行吻合口腔内血管成形术,术后狭窄解除.1例患者人工血管内血栓形成,再次行人工血管旁路转流术治疗,余患者旁路血管通畅,血运较术前明显改善.结论 血管腔内治疗联合外科手术治疗多节段性下肢动脉硬化闭塞症,可降低手术难度与复杂性,减少术后并发症,疗效满意.

Intravascular interventional therapy combined with convention surgery for treatment of lower extremity multilevel atherosclerotic occlusive disease

Objective To study the treatment effect of multilevel atherosclerotic occlusive disease of lower extremity. Methods From July 2004 to January 2008,intraoperative iliac balloon angioplasty and stenting combined with blood vassel prosthesis or autogenous reversed great saphenous vein bypass were performed on 32 patients suffering from lower extremity multilevel atheresclerotic occlusive disease. Results Surgical procedures were technically successful in all patients. The effect was good,intermittent claudication disappear, and rest pain improved. Preoperative vs postoperative ABI was 0.28±0.14 vs 0.65±0.18 (P<0.05 ).Thirty patients were followed up,the mean following period was 18 months (range of 3-36 months).Conclusions Simultaneous intravaseular interventional therapy combined with vascular bypass are effective in the treatment for patients with severe and multilevel atheroselerotie occlusive disease of lower extremity, the operation is less traumatic and the procedures are easy to do.The result is satisfactory.