累及股动脉分叉的多节段下肢动脉硬化闭塞症的杂交手术治疗

目的:探讨杂交手术治疗累及股动脉分叉的多节段下肢动脉硬化闭塞症的临床疗效。方法:回顾2010年10月—2014年12月采用杂交手术治疗46例累及股动脉分叉的多节段下肢动脉硬化闭塞症患者(共47条患肢)的资料。分析相关临床指标,以及病变程度与手术方式对一期通畅率的影响。结果:手术成功率98%(46/47),围手术期无死亡病例,平均踝肱指数由术前的0.34±0.16上升到术后的0.69±0.11。平均随访21.8个月,随访率93%(43/46),累积一期通畅率为67.4%。KaplanMeier分析显示,患肢Fontaine期越高,一期通畅率越低;当患肢手术区域的近、远端都进行腔内干预时,其一期通畅率低于仅在其近端或远端一侧进行干预者(均P0.05)。结论:对于累及股动脉分叉的多节段下肢动脉硬化闭塞病变,杂交手术是一种有效的治疗手段,符合个体化治疗原则。

Hybrid therapy of multisegmental lower extremity arteriosclerosis obliterans involving the femoral artery bifurcation

Objective: To evaluate the clinical efficacy of hybrid procedure in treatment of multisegmental lower extremity arteriosclerosis obliterans (ASO) involving the femoral artery bifurcation. Methods: The data of 46 patients (47 limbs) with multisegmental lower extremity ASO involving the femoral artery bifurcation undergoing hybrid procedure from October 2010 to December 2014 were reviewed. The relevant clinical variables and the influence of the severity of disease and type of procedure on primary patency rate were analyzed. Results: The technical success rate was 98% (46/47), and no perioperative death occurred. The average ankle-brachial index was increased from the preoperative 0.34±0.16 to postoperative 0.69±0.11. The average follow-up time was 21.8 months with a follow-up rate of 93% (43/46), and the cumulative primary patency rate was 67.4%. Kaplan-Meier analysis showed that the primary patency rate was significantly decreased with the higher Fontaine stages of the diseased limb, and primary patency rate was significantly lower when the endovascular intervention was performed in both the proximal and distal segment of the vessel in the surgical area than when performed on only the proximal or distal segment of the vessel (all P<0.05). Conclusion: Hybrid procedure is an effective treatment modality for multisegmental lower extremity ASO involving the femoral artery bifurcation, and it also accords with the principle of individualized therapy.