经腘动脉入路逆行内膜下血管成形术治疗股浅动脉长段硬化性闭塞症的临床研究

目的:探讨经腘动脉入路逆行内膜下血管成形术/支架置入术处理常规入路腔内顺行开通失败的股浅动脉长段硬化性闭塞症的疗效及可行性。方法:50例股浅动脉长段硬化性闭塞症患者行股动脉病侧顺行或健侧逆行推进导丝、导管时无法通过病变动脉到达闭塞段远端的真腔,遂行经腘动脉逆行入路完成内膜下血管成形术。结果:手术即刻支架置入成功率100%,12个月一期通畅率48.0%,二期通畅率92.0%。与术前比较,患者术后踝肱指数(ABI)明显升高,Rutherford分级明显改善(均P0.05)。5例患者术后出现肢体肿胀,3例患者于术后3个月出现腘动脉假性动脉瘤,经治疗均好转。术后1年,再狭窄患者16例(32.0%)。结论:常规入路腔内顺行开通失败的股浅动脉长段硬化性闭塞症患者转行经腘动脉入路逆行内膜下血管成形术/支架置入术有效、可行。

Subintimal angioplasty through retrograde popliteal approach for long superficial femoral artery sclerotic occlusion

Objective: To investigate the effectiveness and feasibility of subintimal angioplasty/stent placement through retrograde popliteal approach for long superficial femoral artery sclerotic occlusion with failed recanalization by conventional endovascular antegrade approach. Methods: The data of fifty patients with long superficial femoral artery sclerotic occlusions, in whom the guide wire and catheter failed to advance into the distal true lumen through the occlusive lesions by antegrade ipsilateral or contralateral femoral approach, and then underwent subintimal angioplasty by retrograde popliteal approach were analysed. Results: The immediate success rate of stent placement was 100%, with primary and secondary patency rate of 48.0% and 92.0% at 12 months. In all the patients, the ankle brachial index (ABI) was increased and Rutherford classification was improved significantly compared with those before operation (all P<0.05). Postoperative limb swelling occurred in 5 patients and popliteal pseudoaneurysm developed in 3 patients at 3 months after operation, which were all improved after treatment. Restenosis occurred after one year in 16 patients (32.0%). Conclusion: Subintimal angioplasty/stent placement through retrograde popliteal approach is effective and feasible in treatment of long superficial femoral artery sclerotic occlusion with failed recanalization after conventional endovascular antegrade approach.