经股、肱动脉联合治疗髂、股动脉长段动脉硬化闭塞症

目的探讨联合经肘/股动脉入路治疗长段髂-股动脉病变的有用性。方法本组共20例患者,男17例,女3例,年龄54～85岁,全部病例均有间歇性跛行、静息痛及下肢发凉。术前踝肱指数0-0.43,PWV为0-1076。全组病例均经CTA或动脉造影证实一侧髂动脉合并对侧股浅动脉长段（≥5cm）闭塞12例,两侧髂动脉合并一侧股浅动脉长段（≥5cm）闭塞3例,一侧髂动脉合并两侧股浅动脉长段（≥5cm）闭塞5例。所有病例均同时行肘/股动脉穿刺。结果 18例患者成功进行腔内球囊/支架治疗,2例未能开通闭塞段。术后踝肱指数0.72±0.15（P〈0.05）,PWV1783-2532（P〈0.05）,与术前相比有显著差异。术后随访1-24个月。其中有1例在随访过程中因心脏疾病死亡,有2例分别在术后6、9个月出现间歇性跛行或静息痛,CTA提示髂股动脉有慢性闭塞,再次成功行球囊扩张术。结论当单一经股动脉路径难以实施时,联合经肘/股动脉入路治疗长段髂-股动脉病变可提高治疗成功率。

Endovascular treatment of long segmental iliac/femoral occlusion via combined femoral and brachial approaches

Objective To investigate the effi cacy of endovascular treatment of long segmental iliac/femoral occlusion via combined transfemoral and brachial approaches. Methods Twenty cases with long segmental occlusions of iliac and femoral arteries were treated by endovascular recanalization of PTA/stenting. The ankle-brachial index（ABI） was 0-0.43 before treatment. 12 cases had long occlusion（≥ 5cm） of unilateral iliac artery and contralateral superfi cial femoral artery,3 cases had occlusion（≥ 5cm） of bilateral iliac artery and unilateral superfi cial femoral artery,5 cases had occlusion（≥ 5cm） of unilateral iliac artery and bilateral superfi cial femoral artery. The occlusions were balloon-dilatated and/or stented with kissing technique via the combined transfemoral/brachial approaches. Results Recanalization was successful in 18 cases with endovascular treatment by PTA and/or stenting. The remaining two cases failed because of severe aortoiliac occlusion. The postoperative ABI was 0.72±0.15,which signifi cantly increased compared with that before treatment（P〈0.05） . All patients were followed for 1-24 months. One patient died of heart disease in follow-up. Two had intermittent claudication or rest pain at 6 and 9 months respectively,and CTA showed restenosis of the lesions. Recanalization was successful by PTA in both the cases. Conclusion For severe lower limb ischemia due to multiple long segmental iliac and femoral arteriosclerotic occlusions,combined transfemoral/brachial approaches are reliable and safe in the cases which were diffi cult to recanalize via single approach.