髋关节区动脉支架植入治疗下肢动脉重症缺血的临床效果评价

doi:10.3877/cma.j.issn.2095-5782.2015.04.003

目的

观察与评价髋关节区支架植入治疗下肢动脉重症缺血的安全性、有效性及对股深动脉血流的影响。

方法

66例动脉硬化闭塞所致下肢重症缺血患者（共70条动脉，均累及股总动脉和/或股动脉近心段）。平均年龄74.6岁。男46例，女20例。左下肢动脉40条，右下肢动脉30条。开通闭塞动脉后，行球囊扩张及支架植入。

结果

术中股动脉急性闭塞3例（局部溶栓后获得通畅），余下肢动脉即刻血流均获得通畅，下肢缺血症状均明显改善。术后15例患肢出现血流过度灌注，无严重并发症发生。随访54例（失访12例），随访时间2～30个月，平均（16.2±2.6）个月。25例因再狭窄或闭塞发生患肢缺血，其中16例接受再次介入治疗（PTA及导管溶栓后获二次通畅）。跨髋关节支架均无断裂，股深动脉均仍保持通畅。6例发生心、脑血管意外，其中2例死亡。

结论

跨髋关节动脉支架植入可安全、有效地改善下肢动脉重症缺血，且不影响股深动脉血流。

关键词: 动脉硬化闭塞，下肢, 球囊扩张, 支架

Objective

To evaluate the clinical safety and effect of arterial stent placement across hip joint for critical lower extremity ischemia and observe the influence of the stent on femoral profound artery patency.

Methods

Sixty-six patients (male 46, female 20) who aged 50-88 years (mean 74.6 years) with critical lower extremity ischemia caused by arteriosclerosis occlusion were reviewed in our study. The total 70 arterial lesions involved the common femoral arteries and/or proximal SFAs. The angioplasty and stents placement after successful canalization was performed in left (40 limbs) and right lower extremity arteries (30 limbs).

Results

The acute thrombosis occurred in three SFAs during the operation, but was dissolved by catheter directed thrombolysis. The other arteries got patency immediately. All ischemia were improved obviously. Fiveteen patients had blood hyper-perfusion in implicated limbs but no severe complication occurred. The follow-up time were (16.2±2.6) months (2-30 months) among 54 cases, the other 12 cases were lost to follow-up. The ischemia due to stenosis or occlusion recurred in 25 cases. Among them, 16 patients received the re-interventional therapy (PTA or catheter directed thrombolysis) and got satisfactory results. In all stents across the hip joint, no fracture occurred and the femoral profound arteries were still patency proved by CTA and DSA examination. Two of six patients with cardiac arrest or stoke died during the follow-up.

Conclusions

Arterial stents placement across hip joint is a safe and effective therapy for critical lower extremity ischemia, and the fluency of femoral profound artery is not affected.

Key words: Arteriosclerosis occlusion, lower extremity, Angioplasty, Stent

图1 患者　男，71岁，右下肢跛行伴静息痛Rutherford-BeckerⅡ级。A：右SFA长段闭塞；B：SFA近心端（髋关节区）植入支架前造影，判断待植入支架长度；C：支架植入后，近心端位于股深动脉开口上方约6 mm；D：术后9个月患者无下肢缺血症状，复查CTA显示支架无变形、断裂，股深动脉通畅。

图2 患者　女，79岁，左下肢静息痛伴足趾部皮肤破损，Rutherford-Becker Ⅲ级。A、B：CTA及DSA显示左SFA长段闭塞；C：植入3枚支架后，股动脉血流通畅，支架近心端位于股深动脉开口上方约1 cm；D：术后14个月动脉再闭塞（支架仍完整、无断裂），股深动脉仍通畅；E：经球囊扩张后；F：左SFA再次获得通畅。

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Evaluation of the clinical effects on the treatment of arterial stent placement across hip joint for critical lower extremity ischemia

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Evaluation of the clinical effects on the treatment of arterial stent placement across hip joint for critical lower extremity ischemia