腔内斑块切除在缺乏流出道的股腘动脉狭窄病变中的应用
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摘要
目的:探讨腔内斑块切除治疗缺乏流出道的股腘动脉狭窄病变的疗效。方法:2014年7月—2015年6月笔者对所在单位21例以重度间歇跛行为主要症状、缺乏远端流出道的股腘动脉狭窄患者进行腔内斑块切除术,并进行随访。结果:与术前比较,患者术后3、6、12个月跛行距离均明显且逐渐增加(均P<0.05);术后2d与3、6、12个月踝肱指数均明显增加(均P<0.05);术后3个月无靶血管再狭窄,术后6个月发现靶血管再狭窄1例(1/21),术后12个月发现靶血管再狭窄2例(2/21),均为中度再狭窄。结论:腔内斑块切除术治疗缺乏流出道的股腘动脉狭窄病变具有较好的近期疗效。
Objective: To investigate the efficacy of endovascular atherectomy in treatment of femoropopliteal artery stenosis with outflow obstruction. Methods: From July 2014 to June 2015, 21 patients who had femoropopliteal artery stenosis with distal outflow tract obstruction and severe intermittent claudication as the main symptom underwent endovascular atherectomy, and then they were followed up.Results: Compared with preoperative findings, the claudication distances of the patients at 3, 6 and 12 months after operation were all significantly increased with a rising trend(all P<0.05), and the ankle-brachial indexes of the patients on 2 d, and at 3, 6 and 12 months after operation were all significantly increased(all P<0.05). Restenosis of the target vessel did not occur in any of the patients at 3 months after operation, but occurred in one case(1/21) 6 months after operation and in 2 cases(2/21) at 12 months after operation, and all stenoses were of a moderate degree.Conclusion: Endovascular atherectomy offers a satisfactory short-term efficacy in treatment of femoropopliteal artery stenosis with outflow obstruction.
Objective: To investigate the efficacy of endovascular atherectomy in treatment of femoropopliteal artery stenosis with outflow obstruction. Methods: From July 2014 to June 2015, 21 patients who had femoropopliteal artery stenosis with distal outflow tract obstruction and severe intermittent claudication as the main symptom underwent endovascular atherectomy, and then they were followed up.Results: Compared with preoperative findings, the claudication distances of the patients at 3, 6 and 12 months after operation were all significantly increased with a rising trend(all P<0.05), and the ankle-brachial indexes of the patients on 2 d, and at 3, 6 and 12 months after operation were all significantly increased(all P<0.05). Restenosis of the target vessel did not occur in any of the patients at 3 months after operation, but occurred in one case(1/21) 6 months after operation and in 2 cases(2/21) at 12 months after operation, and all stenoses were of a moderate degree.Conclusion: Endovascular atherectomy offers a satisfactory short-term efficacy in treatment of femoropopliteal artery stenosis with outflow obstruction.
引文
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[9]谷涌泉,郭连瑞,齐立行,等.Silver Hawk斑块切除治疗动脉粥样硬化导致的下肢缺血14例报告[J].中国微创外科杂志,2011,11(11):1022–1024.doi:10.3969/j.issn.1009–6604.2011.11.021.Gu YQ,Guo LR,Qi LX,et al.Plaque Excision with Silver Hawk Treating Atherosclerotic Lower Extremity Ischemia:Report of 14Cases[J].Chinese Journal of Minimally Invasive Surgery,2011,11(11):1022–1024.doi:10.3969/j.issn.1009–6604.2011.11.021.
[10]Hicks CW,Najafian A,Farber A,et al.Diabetes does not worsen outcomes following infrageniculate bypass or endovascular intervention for patients with critical limb ischemia[J].J Vasc Surg.2016,64(6):1667–1674.doi:10.1016/j.jvs.2016.07.107.
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[13]胡骥琼,王道明,司春强,等.下肢动脉硬化闭塞症侧支循环流出道的解剖学特点及临床应用初探[J].中国修复重建外科杂志,2008,22(5):571–574.Hu JQ,Wang DM,Si CQ,et al.Anatomy and clinical application of bypass circuit outflow tract of arterial sclerosis obstruction[J].Chinese Journal of Reparative and Reconstructive Surgery,2008,22(5):571–574.
[14]Tsetis D,Belli AM.The role of infrapopliteal angioplasty[J].Br J Radiol,2004,77(924):1007–1015.
[15]Shammas NW,Lam R,Mustapha J,et al.Comparison of orbital atherectomy plus balloon angioplasty vs.balloon angioplasty alone in patients with critical limb ischemia:results of the CALCIUM 360randomized pilot trial[J].J Endovasc Ther,2012,19(4):480–488.doi:10.1583/JEVT–12–3815MR.1.
[16]Bunting TA,Garcia LA.Peripheral atherectomy:a critical review[J].J Interv Cardiol,2007,20(6):417–424.
[17]Shafique S,Nachreiner RD,Murphy MP,et al.Recanalization of infrainguinal vessels:silverhawk,laser,and the remote superficial femoral artery endarterectomy[J].Semin Vasc Surg,2007,20(1):29–36.
[18]Keeling WB,Shames ML,Stone PA,et al.Plaque excision with the Silverhawk catheter:early results in patients with claudication or critical limb ischemia[J].J Vasc Surg,2007,45(1):25–31.
[19]Shrikhande GV,Mc Kinsey JF.Use and abuse of atherectomy:where should it be used?[J].Semin Vasc Surg,2008,21(4):204–209.doi:10.1053/j.semvascsurg.2008.11.007.
[20]Lin S,Mc Kinsey JF.Plaque excision for the treatment of infrainguinal arterial occlusive disease[J].Tech Vasc Interv Radiol,2005,8(4):165–168.
[21]Rubin BG.Plaque excision in the treatment of peripheral arterial disease[J].Perspect Vasc Surg Endovasc Ther,2006,18(1):47–52.
[22]郭建明,谷涌泉,郭连瑞,等.Silverhawk斑块切除成形治疗严重膝下动脉硬化闭塞性病变[J].中国普通外科杂志,2014,23(6):732–736.doi:10.7659/j.issn.1005–6947.2014.06.005.Guo JM,Gu YQ,Guo LR,et al.Silverhawk atherectomy and adjunctive angioplasty for severe arterial atherosclerotic occlusive disease below the knee[J].Chinese Journal of General Surgery,2014,23(6):732–736.doi:10.7659/j.issn.1005–6947.2014.06.005.
[23]谷涌泉,郭连瑞,佟铸,等.Silver Hawk治疗长段股总动脉和股浅动脉支架内再狭窄一例[J].中华普通外科杂志,2011,26(3):265–266.doi:10.3760/cma.j.issn.1007–631X.2011.03.037.Gu YQ,Guo LR,Tong Z,et al.Silver Hawk treatment for one case with long-segment stenosis of the common femoral artery and instent restenosis of the superficial femoral artery[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2011,26(3):265–266.doi:10.3760/cma.j.issn.1007–631X.2011.03.037.
[24]Gu Y,Malas MB,Qi L,et al.A comparative study of percutaneous atherectomy for femoropopliteal arterial occlusive disease:experiences in 160 patients[J].Int Angiol,2017,doi:10.23736/S0392–9590.17.03797–X.[Epub ahead of print]]
[2]Mc Kinsey JF,Goldstein L,Khan HU,et al.Novel treatment of patients with lower extremity ischemia:use of percutaneous atherectomy in 579 lesions[J].Ann Surg,2008,248(4):519–528.doi:10.1097/SLA.0b013e318188e1de.
[3]丁明超,李芳,王斌,等.无流出道显影的下肢动脉闭塞症腔内血管成形治疗的预探索[J].介入放射学杂志,2015,24(5):383–387.doi:10.3969/j.issn.1008–794X.2015.05.005.Ding MC,Li F,Wang B,et al.Percutaneous endovascular angioplasty for the treatment of arteriosclerosis obliterans of the lower extremities showing no outflow tract visualization:a preliminary exploration[J].Journal of Interventional Radiology,2015,24(5):383–387.doi:10.3969/j.issn.1008–794X.2015.05.005.
[4]谷涌泉.下肢动脉硬化闭塞症腔内治疗的新进展[J].中国普通外科杂志,2014,23(6):719–723.doi:10.7659/j.issn.1005–6947.2014.06.002.Gu YQ.Endovascular treatment for arteriosclerosis obliterans of lower extremities:resent advances[J].Chinese Journal o f G e n e r a l S u rg e r y,2014,23(6):719–723.d o i:10.7659/j.issn.1005–6947.2014.06.002.
[5]Klein AJ,Ross CB.Endovascular treatment of lower extremity peripheral arterial disease[J].Trends Cardiovasc Med,2016,26(6):495–512.doi:10.1016/j.tcm.2016.02.007.
[6]牛国晨,邹英华.腔内血管成形术治疗膝下动脉缺血性疾病[J].中国介入影像与治疗学,2010,7(2):196–199.Niu GC,Zou YH.Endovascular therapy in the treatment of infrapopliteal arterial occlusive disease[J].Chinese Journal of Interventional Imaging and Therapy,2010,7(2):196–199.
[7]谷涌泉,郭建明.糖尿病膝下动脉病变腔内治疗的新进展[J].中国微创外科杂志,2017,17(4):289–293.doi:10.3969/j.issn.1009–6604.2017.04.001.Gu YQ,Guo JM.Noval Progress of Endovascular Treatment of Diabetic Below Knee Arteries Lesions[J].Chinese Journal of Minimally Invasive Surgery,2017,17(4):289–293.doi:10.3969/j.issn.1009–6604.2017.04.001.
[8]Kokkinidis DG,Armstrong EJ.Emerging and Future Therapeutic Options for Femoropopliteal and Infrapopliteal Endovascular Intervention[J].Interv Cardiol Clin,2017,6(2):279–295.doi:10.1016/j.iccl.2016.12.011.
[9]谷涌泉,郭连瑞,齐立行,等.Silver Hawk斑块切除治疗动脉粥样硬化导致的下肢缺血14例报告[J].中国微创外科杂志,2011,11(11):1022–1024.doi:10.3969/j.issn.1009–6604.2011.11.021.Gu YQ,Guo LR,Qi LX,et al.Plaque Excision with Silver Hawk Treating Atherosclerotic Lower Extremity Ischemia:Report of 14Cases[J].Chinese Journal of Minimally Invasive Surgery,2011,11(11):1022–1024.doi:10.3969/j.issn.1009–6604.2011.11.021.
[10]Hicks CW,Najafian A,Farber A,et al.Diabetes does not worsen outcomes following infrageniculate bypass or endovascular intervention for patients with critical limb ischemia[J].J Vasc Surg.2016,64(6):1667–1674.doi:10.1016/j.jvs.2016.07.107.
[11]Shishehbor MH,Jaff MR.Percutaneous Therapies for Peripheral Artery Disease[J].Circulation,2016,134(24):2008–2027.
[12]Ballotta E,Toniato A,Piatto G,et al.Lower extremity arterial reconstruction for critical limb ischemia in diabetes[J].J Vasc Surg.2014,59(3):708–719.doi:10.1016/j.jvs.2013.08.103.
[13]胡骥琼,王道明,司春强,等.下肢动脉硬化闭塞症侧支循环流出道的解剖学特点及临床应用初探[J].中国修复重建外科杂志,2008,22(5):571–574.Hu JQ,Wang DM,Si CQ,et al.Anatomy and clinical application of bypass circuit outflow tract of arterial sclerosis obstruction[J].Chinese Journal of Reparative and Reconstructive Surgery,2008,22(5):571–574.
[14]Tsetis D,Belli AM.The role of infrapopliteal angioplasty[J].Br J Radiol,2004,77(924):1007–1015.
[15]Shammas NW,Lam R,Mustapha J,et al.Comparison of orbital atherectomy plus balloon angioplasty vs.balloon angioplasty alone in patients with critical limb ischemia:results of the CALCIUM 360randomized pilot trial[J].J Endovasc Ther,2012,19(4):480–488.doi:10.1583/JEVT–12–3815MR.1.
[16]Bunting TA,Garcia LA.Peripheral atherectomy:a critical review[J].J Interv Cardiol,2007,20(6):417–424.
[17]Shafique S,Nachreiner RD,Murphy MP,et al.Recanalization of infrainguinal vessels:silverhawk,laser,and the remote superficial femoral artery endarterectomy[J].Semin Vasc Surg,2007,20(1):29–36.
[18]Keeling WB,Shames ML,Stone PA,et al.Plaque excision with the Silverhawk catheter:early results in patients with claudication or critical limb ischemia[J].J Vasc Surg,2007,45(1):25–31.
[19]Shrikhande GV,Mc Kinsey JF.Use and abuse of atherectomy:where should it be used?[J].Semin Vasc Surg,2008,21(4):204–209.doi:10.1053/j.semvascsurg.2008.11.007.
[20]Lin S,Mc Kinsey JF.Plaque excision for the treatment of infrainguinal arterial occlusive disease[J].Tech Vasc Interv Radiol,2005,8(4):165–168.
[21]Rubin BG.Plaque excision in the treatment of peripheral arterial disease[J].Perspect Vasc Surg Endovasc Ther,2006,18(1):47–52.
[22]郭建明,谷涌泉,郭连瑞,等.Silverhawk斑块切除成形治疗严重膝下动脉硬化闭塞性病变[J].中国普通外科杂志,2014,23(6):732–736.doi:10.7659/j.issn.1005–6947.2014.06.005.Guo JM,Gu YQ,Guo LR,et al.Silverhawk atherectomy and adjunctive angioplasty for severe arterial atherosclerotic occlusive disease below the knee[J].Chinese Journal of General Surgery,2014,23(6):732–736.doi:10.7659/j.issn.1005–6947.2014.06.005.
[23]谷涌泉,郭连瑞,佟铸,等.Silver Hawk治疗长段股总动脉和股浅动脉支架内再狭窄一例[J].中华普通外科杂志,2011,26(3):265–266.doi:10.3760/cma.j.issn.1007–631X.2011.03.037.Gu YQ,Guo LR,Tong Z,et al.Silver Hawk treatment for one case with long-segment stenosis of the common femoral artery and instent restenosis of the superficial femoral artery[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2011,26(3):265–266.doi:10.3760/cma.j.issn.1007–631X.2011.03.037.
[24]Gu Y,Malas MB,Qi L,et al.A comparative study of percutaneous atherectomy for femoropopliteal arterial occlusive disease:experiences in 160 patients[J].Int Angiol,2017,doi:10.23736/S0392–9590.17.03797–X.[Epub ahead of print]]