股浅动脉支架内再狭窄的再干预治疗疗效分析

目的 探讨股浅动脉支架内再狭窄患者再次干预治疗的近期疗效.方法 回顾性分析2011年12月-2013年1月20例股浅动脉支架内再狭窄患者的基本资料、病变特征及再次干预治疗后的症状改善和再狭窄发生情况.结果 20例支架内再狭窄患者就诊时的主要症状为间歇性跛行14例,急性下肢缺血3例,静息痛3例.术前踝肱指数（ankle brachial index,ABI）中位数0.43 （0～0.72）,间歇性跛行距离（238.50±76.80）m.20例患者中65％ （13/20）合并2型糖尿病,45％合并高血压（9/20）,25％合并高脂血症（5/20）.70％ （14/20）为TASCII C／D级病变.再次干预治疗的方法分别为经皮血管腔内成形术（percutaneous transluminal angioplasty,PTA）4例、经皮血管腔内成形术＋支架植入（percutaneous transluminal angioplasty＋stent,PTA＋S）9例、大隐静脉/人工血管旁路术（bypass）3例、斑块旋切治疗（SilverHawk）4例.随访患者14例,平均随访6m （2～18 m）.围手术期未出现死亡、心肌梗死、肾功能不全等并发症,无截肢发生.术后ABI中位数0.69 （0.5～0.85）,与术前ABI相比差异有统计学意义（P＜0.05）.间歇性跛行距离（835.00±217.80）m,（P＜0.01）,术后6m随访时,42.86％患者（6/14）再次出现支架内再狭窄.结论 再次干预治疗可以在近期明显改善支架内再狭窄患者的下肢缺血症状,但仍存在较高的再狭窄率.

Study on the re-intervention effect for SFA in-stent restenosis

Objective To evaluate the efficacy and short-term outcomes of re-intervention in the treatment of in-stent restenosis on superficial-femoral arteries （SFA）. Methods Clinical, angiographic, and procedural data were collected on 20 patients who suffer from SFA in-stent restenosis at a single center from December 2011 to January 2013. We present a retrospective analysis for symptoms improvement and restenosis after re-intervention treatment. Results Among all the pa- tients, 14 were admitted because of intermittent claudication, 3 presented with acute lower limb ischemia, 3 suffer from rest pain. The preoperative ABI ranged from 0 to 0.72 （median 0.43）, the claudication distance was （238.50＋76.80） m. 65 % （13/20） of the patients coexisted with type 2 diabetes, 70 % （14/20） of them were categorized into TASCII grade C ／ D. We selected PTA （4 cases）, PTAS （9 cases）, Bypass （3 cases）, SilverHawk （4 cases） as re-intervention therapy methods. At 6 months, a complete follow-up was obtained in 14 patients. During the perioperative period, no complications such as death, myocardial infarction and kidney dysfunction occurred, no amputation underwent among fol- low-up. Postoperative ABI were revealed ranging from 0.5 to 0.85 （median 0.69）. It was statistically significant compared with the preoperative ABI （P〈0.05）, and claudication distance was （835.00＋217.80） m, （P〈0.01）. 42.86% （6/14） of them occured in-stent restenosis again. Conclusions Re-intervention can significantly improve the short-term outcomes for patients with SFA in-stent restenosis, but there is still a high rate of restenosis after treatment.