SAVVY球囊行PTA治疗下肢动脉流出道硬化闭塞症

目的观察SAVVY球囊治疗下肢动脉流出道硬化闭塞症的近期疗效。方法回顾性分析2008年9月～2009年12月间采用SAVVY球囊行下肢动脉流出道血管PTA的15例共22条患肢,其中男12例,女3例,年龄26～88岁。糖尿病下肢动脉硬化闭塞症11例(18支),非糖尿病下肢动脉硬化闭塞症4例(4支),ABI0.1～0.3有9条,0.3以上13条。球囊直径选择2～4mm,长度10cm。术后低分子肝素皮下注射7d并长期口服阿司匹林或氯吡格雷。监测术后7d及1个月后ABI变化情况,随访半年后复查超声,或根据症状复发情况及时复查血管造影。结果手术技术成功率90.9%(20/22)。4例伴皮肤溃疡或足趾坏疽的肢体最终单侧截肢,其中1例为感染性病变致血管闭塞病例治疗失败,扩张狭窄段后造影管腔未显示开通,再次扩张仍无效;另1例为非糖尿病动脉硬化闭塞症高龄患者多节段狭窄,扩张后管腔狭窄无变化。术中未出现与球囊结构相关的并发症。术后7dABI在14条血管中升高超过0.5,3条超过0.3,3条超过0.1。随访时间平均7.2个月,有5例复发不同程度静息痛。术后7dABI平均为0.74,1个月平均为0.66。结论使用SAVVY长球囊行PTA治疗膝下动脉缺血性病变安全、有效,短期疗效肯定。

Treatment of arteriosclerosis obliterations of outflow tract of lower extremity artery by PTA with SAVVY balloon catheter

Objectives To evaluate the feasibility, safety and short term efficacy of percutaneous transluminal angioplasty on arte- riosclerosis obliterans of outflow tract of lower extremity artery with SAWY balloon catheter. Methods Fifteen patients （twenty-one limbs） with arteriosclerosis obliterans of outflow tract of lower extremity artery were treated by PTA with SAVVY balloon catheters from September 2008 to December 2009. Twelve patients （11/15） suffered from diabetes. Of these lower extremities,15 limbs suffered from rest pain, 8 limbs suffered from ulcer, and 3 limbs suffered from toe gangrene. ABI was 0.1-0.3 in 9 limbs and above in 13 limbs.Balloon diameter is from 2ram to 4mm,lenth is 10era.Results The success rate of operation was 90.9%（20/22）.Pain relieved in 11 limbs, reduced in 3 limbs;4 limbs suffered from ulcer or toe gangrene underwent below-knee amputation. Increase of ABI was more than 0.5 in 14 limbs, 0.31-0.5 in 3 limbs, 0.1-0.3 in 3 limbs. 15 patients were followed up with an average period of 7.2 months（3-12 months）.Pain regained in 5 limbs （5/22）. Average value of ABI was 0.74 one week later and 0.66 one month later. Conclusion PTA with SAVVY balloon catheters in the treatment of arteriosclerosis oblit- erans of outflow tract of lower extremity artery is safe and feasible. Short-tcrmclinical results are encouraging.