经桡动脉途径介入治疗髂动脉股动脉硬化闭塞症

目的 回顾性分析经桡动脉途径介入治疗髂动脉股动脉硬化闭塞症的安全性及其临床疗效.方法 经桡动脉途径介入治疗16例复杂髂动脉股动脉硬化性闭塞症患者,病程3 d至2年.所有患者均合并静息痛,间歇性跛行距离小于500 m,单侧病变9例、双侧病变7例,术前踝肱指数0～0.57(0.32±0.14).髂动脉股动脉完全闭塞6例,其余10例狭窄程度＞75%.留置导管于血栓内或其上方持续滴注尿激酶,如果溶栓72 h没有效果,停止溶栓.血栓溶解后,对残余狭窄程度＞50%的患者给予球囊、支架成形术.比较手术前、后患者的症状及踝肱指数变化,结果采用配对t检验.结果 16例患者溶栓时间3.0～15.0(8.4±2.9)d,15例血管再通.16例患者静息疼痛症状消失;4例仍有间歇性跛行,距离均大于500 m,与术前相比踱行距离明显延长;术后踝肱指数为0.63～1.10(0.91±0.12),较术前明显升高(t=21.73,P＜0.01).随访时间6～24个月,随访期间症状复发1例,再次介入治疗成功.所有患者未发生手术相关严重并发症.结论 经桡动脉途径长时间连续溶栓联合球囊扩张以及支架成形术治疗髂动脉股动脉硬化闭塞症,安全性高、患者耐受性好,是经股动脉途径介入治疗的补充,尤其对于复杂的双侧髂动脉股动脉病变的介入治疗具有更大的优势.

Interventional therapy of arteriosclerotic obliterations of iliaco-femoral artery via radial artery

Objective To study the safety and effect of interventional treatment for arteriesclerotic obliterations of iliaco-fermoral artery via radial artery retrospectively.Methods Sixteen cages were treated with interventional procedare via radial artery.The duration of disease was from 3 days to 2 years.All cases presented with rest pain and intermittent claudicating(with distance less than 500 m).Unilateral lesions were found in 9 cases.and bilateral lesions in 7 cases.Iliaco-femoral arteries were obliterated completely in 6 cases.while the other ten cases had arterial stenesis more than 75%.After visualization of obliterative artery.urokinase was administrated consecutively from catheter indweUed in or above thrombus.Transcatheter thrombolysis would be cancelled if the therapeutic effect wag negligible after using umkinase for 72 hours.After thrombolysis.the balloon angioplasty and the stent implantation were performed in the cases with residual stenesis more than 50%. In all of 16 cases,5 caseg underwent continuous intraarterial thrombolysis only.11 cases received balloon angioplasty and/or stent implantation additionally.The ankle/braehial index(ABI)post-treatment and pre-treatment was analyzed.Results The duration of transcatheter thrombolysis was 3.0-15.0 days,averaged(8.4±2.9)days.The obliterative arteries were recanalized in 15 cases.The symptoms of rest pain disappeared in all cases.while intermittent claudicating was still present in 4 cases,but the claudicating distance increased significantly(92.50±60.21 and 625.00±84.26 m for pre-and post-operation respectively).The ABl was 0.63-1.10(0.91±0.12)for post-treatment and 0-4).57(0.32±0.14)for pre-treatment respectively(t=21.73,P＜0.01).During 6-24 months' follow-up,restenosis occurred in 1 case,which was treated successfully once again after halloon angioplasty.There was no serious complication related to the procedure.Conclusion It is safe and effective to apply continuous thrombolysis combined with balloon angioplasty and stent implantation to treat iliacofemoral artery obliteration interventionally via radial arterv.