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中华介入放射学电子杂志 ›› 2018, Vol. 06 ›› Issue (03) : 226 -231. doi: 10.3877/cma.j.issn.2095-5782.2018.03.010

所属专题: 文献

血管介入

斑块旋切术联合药物涂层球囊治疗股腘动脉病变的应用研究
师贞爱1, 李承志1, 张红1, 刘玉龙1, 李王海1, 张艳1,()   
  1. 1. 510632 广州,暨南大学附属第一医院介入与血管外科
  • 收稿日期:2018-01-19 出版日期:2018-08-01
  • 通信作者: 张艳
  • 基金资助:
    中央高校基本科研业务费专项资金资助(21617318)

Application of directional atherectomy combined with paclitaxel-coated balloon angioplasty in treatment of femoropopliteal occlusion

Zhenai Shi1, Chengzhi Li1, Hong Zhang1, Yulong Liu1, Wanghai Li1, Yan Zhang1,()   

  1. 1. Department of Interventional Radiology, the First Affiliate Hospital of Jinan University, Guangzhou 510632, China
  • Received:2018-01-19 Published:2018-08-01
  • Corresponding author: Yan Zhang
  • About author:
    Corresponding author:Zhang Yan,Email:
引用本文:

师贞爱, 李承志, 张红, 刘玉龙, 李王海, 张艳. 斑块旋切术联合药物涂层球囊治疗股腘动脉病变的应用研究[J]. 中华介入放射学电子杂志, 2018, 06(03): 226-231.

Zhenai Shi, Chengzhi Li, Hong Zhang, Yulong Liu, Wanghai Li, Yan Zhang. Application of directional atherectomy combined with paclitaxel-coated balloon angioplasty in treatment of femoropopliteal occlusion[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2018, 06(03): 226-231.

目的:

探讨TurboHawk斑块旋切导管(DA)联合紫杉醇药物涂层球囊(PCB)治疗下肢股腘动脉(FPA)狭窄及闭塞性病变的疗效及安全性。

方法:

选取2016年9月-2017年8月我院收治的17例下肢动脉硬化闭塞症患者,男11例,女6例,平均年龄(73.2±7.5)岁,14例(82%)患肢Rutherford分级>4级,表现为患肢严重缺血,靶病变为股腘动脉,接受了DA联合PCB的腔内治疗方案。术前、术后常规双联抗血小板治疗,术后3、6、12个月复查患肢踝肱指数(ABI)、彩色超声或CTA随访。

结果:

17例患者接受了上述治疗方案,平均病变长度为(286.1±69.4)mm,全部靶病变血管再通成功,1例顽固性狭窄行支架补救,技术成功率为94.1%(16/17),8例术前已有足趾坏死者接受截趾术,均经治疗创面完全愈合且不影响行走。术后即刻患肢缺血症状改善,Rutherford分级明显下降,差异均有统计学意义,术后ABI比术前明显提高(0.99±0.10 vs. 0.30±0.19,t=15.31,P<0.05)。随访3~14个月,平均(7.4±3.8)个月,全部患者下肢缺血症状无复发,保肢率为100%;随访期间未见明显需手术干预的复发狭窄,一期管腔通畅率为100%。住院及随访期间无严重手术相关并发症。

结论:

DA联合PCB治疗下肢股腘动脉病变是安全有效的,近期通畅率高。

Objective:

To evaluate the safety and effect of directional atherectomy (DA) combined with paclitaxel-coated balloon (PCB) angioplasty in treatment of atherosclerotic lesions in femoropopliteal artery.

Methods:

Seventeen cases with femoropopliteal occlusion[mean age of (73.2±7.5) years-old; 11 male and 6 female] were analyzed. In 14 cases (82%) , the Rutherford level of the affected limb was >4 grade, presented with critical limb ischemia, underwent treatment with DA and PCB angioplasty under filter protection between September 2016 and August 2017. Dual antiplatelet therapy was indicated per-and post-operation. The ankle-brachial index (ABI) was detected before the intervention, after 3, 6 and 12 months. Also clinical examination and target lesion duplex ultrasound scans or computed tomographic angiography (CTA) were done in the observation period.

Results:

There were 17 cases enrolled, the treated lesion length was (286.1±69.4) mm. Successful recanalization of all target lesions, one refractory stenosis was treated with bailout stenting. The technical success rate was 94.1%. In eight cases with toe necrosis before operation, foot finger amputations were performed after procedure, to reach complete wound healing and/or preserve deambulation. The post-operation ABI was significantly higher than per-operation (0.99±0.10 vs. 0.30±0.19, t=15.31, P<0.05) . The mean follow-up was (7.4±3.8) months (3-14 months) . During follow-up, no restenosis requiring re-intervention was found, the primary patency was 100%, and no DA-related adverse event and symptom recurrence was observed, with the limb salvage rate of 100%.

Conclusion:

The DA combined with PCB might be an effective and safe method with a promising high rate of patency.

表1 17例患者的靶病变特点
图1 典型病例1(男,70岁,右股浅动脉节段性狭窄)采用斑块旋切术联合药物球囊术治疗前后
图2 典型病例1(男,75岁,左股浅动脉支架内再闭塞)采用斑块旋切术联合药物球囊术治疗前后
图3 保护伞内捕获的栓子及旋切的斑块
表2 斑块旋切术联合药物球囊技术治疗前后血管狭窄率、ABI及Rutherford分级对比(±s)或M(P25P75
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