血栓闭塞性脉管炎的腔内治疗

目的 探讨血栓闭塞性脉管炎(thromboangitis obliterans,TAO)的腔内治疗方法.方法 总结上海中山医院血管外科2006年4月至2008年5月收治TAO患者16例(18条下肢)TAO患者的临床资料.对病变肢体行下肢造影,根据术前CTA结果显示的流入道和流出道情况行置管溶栓术和球囊扩张成形术.结果 本组16例患者18条肢体行球囊扩张成形术(percutaneous transluminal plasty,PTA),3条肢体术后无明显改善,其中1例手术2周后行膝上截肢术.FFA即时成功率为83.34%(15/18).术后15条患肢皮温明显升高,间歇性跛行消失或跛行距离延长,静息痛消失或明显减轻,9例足背或胫后动脉搏动恢复.术后1周踝/肱指数由术前0.33±0.16恢复至0.79±0.23.8例有足趾坏死者渗出消失、创丽愈合.术后随访16例,随访率100%,随访时间2～24个月,平均随访10.84个月.以下肢CTA和A/BI检杏行术后随访,术后3个月的通畅率为81.33%,1年通畅率为60.23%.结论 TAO患者行PTA能改善患肢血供,促进溃疡及创面的愈合,增加保肢率,降低截肢平面.近期效果满意,是一种可供选择的新的治疗途径.

Percutaneous translumiaal angioplasty for the treatment of thromboangitis obliterans

Objective To investigate the value of endovascular surgery for the treatment of thromboangitis obliterans (TAO). Methods Sixteen patients (18 limbs) with thromboangitis obliterans were treated by percutaneous transluminal plasty (PTA). Results Angiographic success on the limb basis was achieved in 15 of 18 treated limbs and the initial technical success rate was 83.34%. Doppler anklebrachial index (ABI) increased from 0.33±0.16 to 0.79±0.23 one week after PTA. The follow-up time was 2～24 months, the average time was 10.84 months. The 3-month, 12-month accumulated primary patency rate were 81.33% and 60. 23% respectively. Conclusion PTA is effective primary invasive treatment for thromboangitis obliterans yielding acceptable primary clinical success with a low complication rate and resulting in moderate long-term clinical patency and a high limb salvage rate.