腔内修复治疗创伤性腘动脉损伤临床分析
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摘要
目的评价创伤性腘动脉损伤的腔内修复效果和治疗经验。方法回顾性分析2010年1月～2017年2月我院收治的21例创伤性腘动脉损伤患者资料。男18例,女3例;年龄23～64岁,平均(37.8±11.9)岁。致伤原因包括交通伤9例,机器挤压伤4例,坠落伤3例,重物砸伤3例,医源性损伤1例,锐器伤1例。患者术前行彩色多普勒超声或CT血管造影显示腘动脉损伤情况,并经术中动脉造影确诊,选择覆膜支架、裸支架或裸支架辅助弹簧圈栓塞方法行腔内修复治疗。结果21例患者手术成功率100%,腔内修复治疗后立刻重建血流通道,腘动脉损伤段管腔血流通畅,破口被完全隔绝,无对比剂滞留、外溢。围手术期并发症3例,其中1例为胫后动脉穿刺点血肿,2例为术后患肢出现骨筋膜室综合征,分别给予对症处理后恢复良好。21例获随访6～50个月,平均(23.2±12.1)个月,1例支架腔内狭窄>50%,予以球囊扩张治疗后支架内血流恢复通畅;其余移植物在随访期内通畅。结论腔内修复治疗创伤性腘动脉损伤近、中期效果好,是一种安全、可行的方法。
Objective To evaluate the efficacy of endovascular repair of popliteal artery injuries. Methods The clinical data of 21 patients( 18 men, 3 women, age range : 23-64 years, mean : 37. 8 ± 11. 9 years) with popliteal artery injuries treated at our hospital from January 2010 to February 2017 were retrospectively analyzed. The types of trauma included motor vehicle acci-dent( 9), machine crush( 4), fall from heights( 3), impact by falling object( 3), stab wound( 1), and iatrogenic injury( 1). Ultra-sound or CT angiography was performed prior to endovascular repair using covered stent, bare-metal stent, or stent-assisted coil.Results Endovascular repair was successful on all patients with reconstruction of the blood flow channels, recovery of popliteal artery blood flow, isolation of the puncture in the artery, and no contrast extravasation. Perioperative complication included hematoma in the posterior tibial artery puncture site( 1) and compartment syndrome( 2) with recovery after symptomatic treatment.At 6-50 month follow-up( mean duration : 23. 2 ± 12. 1 months), 1 patient with greater than 50% stent stenosis required second balloon dilation. All other grafts remained patent. Conclusion Endovascular treatment of popliteal artery injuries is safe and effective in short-to mid-term follow-up.
Objective To evaluate the efficacy of endovascular repair of popliteal artery injuries. Methods The clinical data of 21 patients( 18 men, 3 women, age range : 23-64 years, mean : 37. 8 ± 11. 9 years) with popliteal artery injuries treated at our hospital from January 2010 to February 2017 were retrospectively analyzed. The types of trauma included motor vehicle acci-dent( 9), machine crush( 4), fall from heights( 3), impact by falling object( 3), stab wound( 1), and iatrogenic injury( 1). Ultra-sound or CT angiography was performed prior to endovascular repair using covered stent, bare-metal stent, or stent-assisted coil.Results Endovascular repair was successful on all patients with reconstruction of the blood flow channels, recovery of popliteal artery blood flow, isolation of the puncture in the artery, and no contrast extravasation. Perioperative complication included hematoma in the posterior tibial artery puncture site( 1) and compartment syndrome( 2) with recovery after symptomatic treatment.At 6-50 month follow-up( mean duration : 23. 2 ± 12. 1 months), 1 patient with greater than 50% stent stenosis required second balloon dilation. All other grafts remained patent. Conclusion Endovascular treatment of popliteal artery injuries is safe and effective in short-to mid-term follow-up.
引文
[1]刘斌,朱化刚,李永生.腘动脉损伤及早诊断与治疗方法的临床研究.安徽医科大学学报,2015,50:1504-1506.
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[10]Sloan K,Mofidi R,Nagy J,et al.Endovascular treatment for traumatic popliteal artery pseudoaneurysms after knee arthroplasty.Vasc Endovascular Surg,2009,43:286-290.
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[12]Trellopoulos G,Georgiadis GS,Aslanidou EA,et al.Endovascular management of peripheral arterial trauma in patients presenting in hemorrhagic shock.J Cardiovasc Surg,2012,53:495-506.
[13]Zhou W,Bush RL,Terramani TT,et al.Treatment options of iatrogenic pelvic vein injuries:conventional operative versus endovascular approach--case reports.Vasc Endovascular Surg,2004,38:569-573.
[14]袁锋,梁惠民,韩萍,等.腔内介入治疗锁骨下动脉外伤性假性动脉瘤.临床放射学杂志,2013,32:1484-1488.
[15]Shalhub S,Starnes BW,Tran NT.Endovascular treatment of axillosubclavian arterial transection in patients with blunt traumatic injury.J Vasc Surg,2011,53:1141-1144.
[16]Zhong S,Zhang X,Chen Z,et al.Endovascular repair of blunt popliteal arterial injuries.Korean J Radiol,2016,17:789-796.
[17]Lammer J,Zeller T,Hausegger KA,et al.Heparin-bonded covered stents versus bare-metal stents for complex femoropopliteal artery lesions:the randomized VIASTAR trial(Viabahn endoprosthesis with PROPATEN bioactive surface[VIA]versus bare nitinol stent in the treatment of long lesions in superficial femoral artery occlusive disease).J Am Coll Cardiol,2013,62:1320-1327.
[18]Pedersen G,Laxdal E,Ellensen V,et al.Improved patency and reduced intimal hyperplasia in PTFE grafts with luminal immobilized heparin compared with standard PTFE grafts at six months in a sheep model.J Cardiovasc Surg,2010,51:443-448.
[19]苏浩波,顾建平,楼文胜,等.自发性孤立性肠系膜上动脉夹层的CT诊断和介入治疗(附6例报道).临床放射学杂志,2012,31:1324-1329.
[20]郭媛媛,金辉.多层裸支架腔内隔绝动脉瘤的研究现状及存在问题.中国普通外科杂志,2012,21:1566-1570.
[21]Ruffino MA,Rabbia C,Italian Cardiatis Registry Investigators Group.Endovascular repair of peripheral and visceral aneurysms with the Cardiatis multilayer flow modulator:one-year results from the Italian Multicenter Registry.J Endovasc Ther,2012,19:599-610.
[2]Franz RW,Shah KJ,Halaharvi D,et al.A 5-year review of management of lower extremity arterial injuries at an urban level I trauma center.J Vasc Surg,2011,53:1604-1610.
[3]Reuben BC,Whitten MG,Sarfati M,et al.Increasing use of endovascular therapy in acute arterial injuries:analysis of the National Trauma Data Bank.J Vasc Surg,2007,46:1222-1226.
[4]Burkhardt GE,Rasmussen TE,Propper BW,et al.A national survey of evolving management patterns for vascular injury.JSurg Educ,2009,66:239-247.
[5]Kauvar DS,Sarfati MR,Kraiss LW.National trauma databank analysis of mortality and limb loss in isolated lower extremity vascular trauma.J Vasc Surg,2011,53:1598-1603.
[6]Halvorson JJ,Anz A,Langfitt M,et al.Vascular injury associated with extremity trauma:initial diagnosis and management.JAm Acad Orthop Surg,2011,19:495-504.
[7]郭大乔,郭宝磊.腘动脉损伤的诊断和处理要点.中国实用外科杂志,2014,34:1158-1160.
[8]Margolies MN,Ring EJ,Waltman AC,et al.Arteriography in the management of hemorrhage from pelvic fractures.N Engl JMed,1972,287:317-321.
[9]Macedo FI,Sciarretta JD,Salsamendi J,et al.Repair of an acute blunt popliteal artery trauma via endovascular approach.Ann Vasc Surg,2015,29:366.e5-366.e10.
[10]Sloan K,Mofidi R,Nagy J,et al.Endovascular treatment for traumatic popliteal artery pseudoaneurysms after knee arthroplasty.Vasc Endovascular Surg,2009,43:286-290.
[11]von Stumm M,Teufelsbauer H,Reichenspurner H,et al.Two decades of endovascular repair of popliteal artery aneurysm-a meta-analysis.Eur J Vasc Endovasc Surg,2015,50:351-359.
[12]Trellopoulos G,Georgiadis GS,Aslanidou EA,et al.Endovascular management of peripheral arterial trauma in patients presenting in hemorrhagic shock.J Cardiovasc Surg,2012,53:495-506.
[13]Zhou W,Bush RL,Terramani TT,et al.Treatment options of iatrogenic pelvic vein injuries:conventional operative versus endovascular approach--case reports.Vasc Endovascular Surg,2004,38:569-573.
[14]袁锋,梁惠民,韩萍,等.腔内介入治疗锁骨下动脉外伤性假性动脉瘤.临床放射学杂志,2013,32:1484-1488.
[15]Shalhub S,Starnes BW,Tran NT.Endovascular treatment of axillosubclavian arterial transection in patients with blunt traumatic injury.J Vasc Surg,2011,53:1141-1144.
[16]Zhong S,Zhang X,Chen Z,et al.Endovascular repair of blunt popliteal arterial injuries.Korean J Radiol,2016,17:789-796.
[17]Lammer J,Zeller T,Hausegger KA,et al.Heparin-bonded covered stents versus bare-metal stents for complex femoropopliteal artery lesions:the randomized VIASTAR trial(Viabahn endoprosthesis with PROPATEN bioactive surface[VIA]versus bare nitinol stent in the treatment of long lesions in superficial femoral artery occlusive disease).J Am Coll Cardiol,2013,62:1320-1327.
[18]Pedersen G,Laxdal E,Ellensen V,et al.Improved patency and reduced intimal hyperplasia in PTFE grafts with luminal immobilized heparin compared with standard PTFE grafts at six months in a sheep model.J Cardiovasc Surg,2010,51:443-448.
[19]苏浩波,顾建平,楼文胜,等.自发性孤立性肠系膜上动脉夹层的CT诊断和介入治疗(附6例报道).临床放射学杂志,2012,31:1324-1329.
[20]郭媛媛,金辉.多层裸支架腔内隔绝动脉瘤的研究现状及存在问题.中国普通外科杂志,2012,21:1566-1570.
[21]Ruffino MA,Rabbia C,Italian Cardiatis Registry Investigators Group.Endovascular repair of peripheral and visceral aneurysms with the Cardiatis multilayer flow modulator:one-year results from the Italian Multicenter Registry.J Endovasc Ther,2012,19:599-610.