探讨超声引导逆穿膝下动脉后行双向内膜下血管成形术在治疗下肢动脉硬化闭塞症（ASO）中的临床效果和应用价值。

选取2012年1月—2016年12月在南通市第一人民医院采用超声引导逆穿膝下动脉后行双向内膜下血管成形术治疗的ASO患者15例，超声引导下将微穿刺针穿入目标血管，引入微导丝，交换引入微导管、泥鳅导丝及导管，造影确认是动脉后，将导丝反复试探上送，并逐渐通过闭塞段，与下行导管会合Kiss后行血管成形术。

15例超声引导下逆穿均获技术成功，无严重并发症发生，顺利行双向内膜下血管成形术。15例总手术时间平均为45～180 min，其中超声引导平均时间为5 min（2～15 min），术中平均出血量20 ml。

超声引导逆穿是一种安全、方便、可信赖的方法，可以减少操作时间、提高SIA成功率，值得临床推广使用。

To investigate the clinical effect and application value of ultrasound-guided subintimal angioplasty with antegrade-retrograde intervention in the arteries below-the-knee of patients with arteriosclerosis obliterans (ASO).

Between January 2012 and December 2016, 15 ASO patients who underwent subintimal angioplasty with antegrade-retrograde intervention guided by ultrasound in the arteries below-the-knee in the First People's Hospital of Nantong were selected for this study. Under the guidance of ultrasound, a micro-needle was punctured into the target vessel, introducing the micro wire, micro sheath, guidewire and sheath in turns. Upon confirmation by angiography, the guidewire was pushed upstream repeatedly and crossed the occlusion gradually. When it kissed with the downward sheath, the subintimal angioplasty was then performed.

Retrograde punctures in 15 cases were technically successful with no occurrence of serious complications and the subintimal angioplasties with antegrade-retrograde intervention all succeeded. The total operation time of the 15 cases averaged 45-180 min, of which 5 min (2-15 min) for ultrasound-guided procedures. The average amount of intra-operative blood loss was 20 ml.

Ultrasound-guided retrograde puncture is a safe, convenient and reliable approach that is worth of clinical application, because it not only reduces the operation time but also improves the success rate of SIA.