超声消融治疗下肢动脉闭塞症的临床研究

目的：介绍血管内超声消融治疗下肢动脉闭塞症的临床应用效果。方法：对39例患者进行下肢动脉造影确定动脉闭塞部位,15例采用经皮动脉穿刺方法,24例采用显露切开方法。在血管造影监测和导丝的导引下缓慢将超声消融导管插入到闭塞动脉的斑块和血栓处,通过超声发射器向导管尖端释放高能低频超声能量进行消融。分别取材超声消融前后动脉闭塞部位的动脉血管做病理学分析;在高倍显微镜下测量超声消融后局部动脉血内斑块的最大直径。结果：39例患者中37例闭塞的动脉经超声消融后管腔明显变宽,有12例患者术中超声消融后接受动脉内血管支架治疗,有4例术后发生脚趾急性缺血症状,35例随访患者中血管通畅率达83%,再闭塞率为17%。超声消融治疗前后采样的动脉血管组织学对比变化明显,超声消融治疗后采集的血样分析最小斑块直径显示最小微粒为7μm,最大微粒为200μm,其中22例微粒为7～9μm,有12例微粒为10～100μm,有5例微粒达200μm。结论：血管内超声消融可以有效地治疗下肢动脉闭塞症血管内斑块和血栓。

The Clinical Effect of Unltrasound Ablation in Therapy of Artery Obliteration of Lower Extremity

Objective： To introuduce the clinical effect of unltrasound ablation in therapy of artery obliteration of lower extremity. Methods： 39 patients underwent arteriography of lower extremity to identify ablation region. 15 patients underwent Percutaneous arteriopuncture and the other 24 patients underwent section. Catheter was inserted with guide line to the plaque and thrombus . The unltrasound projector released high-energetic and low- frequency energy to the tip of the catheter for ablation. Arteriovascular specimen at the lesion was acquired before and after ablation for pathologic analysis. Plaque was measured after ablation with high power microscope. Result： The Arteriovascular lumen was widen obviously in 37 out of 39 patients after ablation. 12 patients underwent intravascular stents and 4 patients complicated with toes acute ischemia after ablation.The follow-up patency rate in 35 patients is 83% while the reobliteration rate is 17%. There was significence in plaque diameter which is 7μm at least and 200 μm at most （10-100 μm in 12 patients and 200 μm in 5 patients.） after ablation. Conclusion： Intravascular unltrasound ablation is an effective therapy for artery obliteration of lower extremity patients.