SilverHawk斑块切除系统治疗膝下动脉硬化闭塞
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摘要
目的探讨SilverHawk斑块切除系统治疗膝下动脉硬化闭塞的临床效果。方法采用SilverHawk斑块切除系统治疗34例(39条患肢)膝下动脉硬化闭塞患者,观察治疗效果及随访结果。结果患者围手术期无死亡。39条患肢中,31条(28例患者)顺行开通成功,8条(6例)逆行开通成功,治疗成功率100%(39/39),技术成功率92.31%(36/39)。术后1周患者跛行距离、趾肱指数(TBI)及踝肱指数(ABI)均高于术前(P均<0.05)。术后随访2～46个月,平均(23.63±9.71)个月,溃疡愈合率90.00%(9/10);4条坏疽患肢中,1条膝下截肢。术后6、12、24个月患肢一期通畅率分别为87.18%(34/39)、82.05%(32/39)及71.79%(28/39),二期通畅率分别为94.87%(37/39)、92.31%(36/39)和84.62%(33/39)。结论采用SilverHawk斑块切除系统治疗膝下动脉硬化闭塞效果良好。
Objective To explore the therapeutic effect of SilverHawk atherectomy in the treatment of atherosclerotic occlusion of infrapopliteal arteries.Methods SilverHawk atherectomy was used to treat 34 patients(39 limbs)with atherosclerotic occlusion of infrapopliteal arteries.Then the therapeutic results and follow-up results were observed.Results There was no death during the perioperative period of SilverHawk atherectomy.Totally 31 limbs(28 cases)were treated antegradely,while 8 limbs(6 cases)were punctured retrogradely.The procedural success rate was 100%(39/39),and the technical success rate was 92.31%(36/39).One week after atherectomy,the claudication distance,toe brachial index(TBI)and ankle brachial index(ABI)were all higher than those before atherectomy(all P<0.05).All patients were followed up for 2 to 46 months(mean[23.63±9.71]months),the ulcer healing rate was 90.00%(9/10),and 1 of4 gangrenous limbs underwent amputation below the knee.The primary patency rate at 6,12,24 months was 87.18%(34/39),82.05%(32/39)and 71.79%(28/39),respectively,while the secondary patency rate was 94.87%(37/39),92.31%(36/39)and 84.62%(33/39),respectively.Conclusion SilverHawk atherectomy is effective in treatment of atherosclerotic occlusion of infrapopliteal artery.
Objective To explore the therapeutic effect of SilverHawk atherectomy in the treatment of atherosclerotic occlusion of infrapopliteal arteries.Methods SilverHawk atherectomy was used to treat 34 patients(39 limbs)with atherosclerotic occlusion of infrapopliteal arteries.Then the therapeutic results and follow-up results were observed.Results There was no death during the perioperative period of SilverHawk atherectomy.Totally 31 limbs(28 cases)were treated antegradely,while 8 limbs(6 cases)were punctured retrogradely.The procedural success rate was 100%(39/39),and the technical success rate was 92.31%(36/39).One week after atherectomy,the claudication distance,toe brachial index(TBI)and ankle brachial index(ABI)were all higher than those before atherectomy(all P<0.05).All patients were followed up for 2 to 46 months(mean[23.63±9.71]months),the ulcer healing rate was 90.00%(9/10),and 1 of4 gangrenous limbs underwent amputation below the knee.The primary patency rate at 6,12,24 months was 87.18%(34/39),82.05%(32/39)and 71.79%(28/39),respectively,while the secondary patency rate was 94.87%(37/39),92.31%(36/39)and 84.62%(33/39),respectively.Conclusion SilverHawk atherectomy is effective in treatment of atherosclerotic occlusion of infrapopliteal artery.
引文
[1] MahéG,Kaladji A,Le Faucheur A,et al.Internal iliac artery disease management:Still absent in the update to TASCⅡ(Inter-Society Consensus for the Management of Peripheral Arterial Disease).J Endovasc Ther,2016,23(1):233-234.
[2]张艳,王晓白,李承志,等.Silverhawk斑块旋切系统治疗下肢动脉硬化闭塞症.中国介入影像与治疗学,2012,9(5):339-342.
[3]谷涌泉,郭建明.膝下动脉缺血的治疗选择:旁路还是腔内治疗?中国血管外科杂志(电子版),2013,5(2):80-82.
[4] Strm M,Konge L,L9nn L,et al.Amputation-free survival after crural percutaneous transluminal angioplasty for critical limb ischemia.Scand J Surg,2016,105(1):42-48.
[5]谷涌泉,郭连瑞,齐立行,等.膝下动脉支架成形术治疗严重下肢缺血.中华普通外科杂志,2012,27(3):184-186.
[6] Biondi-zoccai GG,Sangiorgi G,Lotrionte M,et al.Infragenicular stent implantation for below-the-knee atherosclerotic disease:Clinical evidence from an international collaborative meta-analysis on 640patients.J Endovasc Ther,2009,16(3):251-260.
[7] Siablis D,Karnabatidis D,Katsanos K,et al.Sirolimus-eluting versus bare stents after suboptimal infrapopliteal angioplasty for critical limb ischemia:Enduring 1-year angiographic and clinical benefit.J Endovasc Ther,2007,14(2):241-250.
[8] Minko P,Buecker A,Jaeger S,et al.Three-year results after directional atherectomy of calcified stenotic lesions of the superficial femoral artery.Cardiovasc Intervent Radiol,2014,37(5):1165-1170.
[9]孙利坤,王兵,刘俊超,等.SilverHawk斑块切除系统在股腘动脉硬化闭塞性疾病中的应用.实用医学杂志,2017,33(18):3060-3063.
[10] Rastan A,Mckinsey JF,Garcia LA,et al.One-year outcomes following directional atherectomy of infrapopliteal artery lesions:Subgroup results of the prospective,multicenter DEFINITIVE LE trial.J Endovasc Ther,2015,22(6):839-846.
[11]谷涌泉.膝下动脉硬化闭塞症腔内治疗的原则.中华医学杂志,2014,94(46):3617-3618.
[12] Lo RC,Darling J,Bensley RP,et al.Outcomes following infrapopliteal angioplasty for critical limb ischemia.J Vasc Surg,2013,57(6):1455-1463.
[2]张艳,王晓白,李承志,等.Silverhawk斑块旋切系统治疗下肢动脉硬化闭塞症.中国介入影像与治疗学,2012,9(5):339-342.
[3]谷涌泉,郭建明.膝下动脉缺血的治疗选择:旁路还是腔内治疗?中国血管外科杂志(电子版),2013,5(2):80-82.
[4] Strm M,Konge L,L9nn L,et al.Amputation-free survival after crural percutaneous transluminal angioplasty for critical limb ischemia.Scand J Surg,2016,105(1):42-48.
[5]谷涌泉,郭连瑞,齐立行,等.膝下动脉支架成形术治疗严重下肢缺血.中华普通外科杂志,2012,27(3):184-186.
[6] Biondi-zoccai GG,Sangiorgi G,Lotrionte M,et al.Infragenicular stent implantation for below-the-knee atherosclerotic disease:Clinical evidence from an international collaborative meta-analysis on 640patients.J Endovasc Ther,2009,16(3):251-260.
[7] Siablis D,Karnabatidis D,Katsanos K,et al.Sirolimus-eluting versus bare stents after suboptimal infrapopliteal angioplasty for critical limb ischemia:Enduring 1-year angiographic and clinical benefit.J Endovasc Ther,2007,14(2):241-250.
[8] Minko P,Buecker A,Jaeger S,et al.Three-year results after directional atherectomy of calcified stenotic lesions of the superficial femoral artery.Cardiovasc Intervent Radiol,2014,37(5):1165-1170.
[9]孙利坤,王兵,刘俊超,等.SilverHawk斑块切除系统在股腘动脉硬化闭塞性疾病中的应用.实用医学杂志,2017,33(18):3060-3063.
[10] Rastan A,Mckinsey JF,Garcia LA,et al.One-year outcomes following directional atherectomy of infrapopliteal artery lesions:Subgroup results of the prospective,multicenter DEFINITIVE LE trial.J Endovasc Ther,2015,22(6):839-846.
[11]谷涌泉.膝下动脉硬化闭塞症腔内治疗的原则.中华医学杂志,2014,94(46):3617-3618.
[12] Lo RC,Darling J,Bensley RP,et al.Outcomes following infrapopliteal angioplasty for critical limb ischemia.J Vasc Surg,2013,57(6):1455-1463.