机械血栓清除术治疗急性-亚急性股腘动脉支架内血栓21例
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摘要
目的探讨机械血栓清除术(percutaneous mechanical thrombectomy,PMT)治疗急性-亚急性股腘动脉支架内血栓的疗效。方法 2016年1月～2018年1月对21例因急性-亚急性股腘动脉支架内血栓行PMT(16例选择Rotarex机械血栓切除系统,5例选择AngioJet机械血栓切除系统),17例辅助动脉置管溶栓(catheter directed thrombolysis,CDT)和经皮血管腔内成形术(percutaneous transluminal angioplasty,PTA)、支架成形术。结果病变长度(15.5±4.9) cm。技术成功率Angiojet组100%(5/5);Rotarex组68.8%(11/16),5例联合CDT后成功率100%。辅助CDT 5例,残余病变行单纯PTA 12例,PTA辅助支架成形2例。临床成功率90.5%(19/21)。术后踝肱指数(ankle-brachial index,ABI)中位数0.72(0.40～1.20),明显高于术前中位数0.26(0.00～0.76)(Z=-3.640,P=0.001)。远端动脉栓塞发生率28.6%(6/21),穿刺点出血3例(14.3%),无穿孔、夹层、支架移位和肾功能衰竭并发症。21例随访(13.5±6.1)月,6个月一期通畅率81.1%(17/21),二期通畅率100.0%(21/21),无死亡,1例(4.8%)术后2个月患足因坏疽合并感染行足部截肢。结论机械血栓清除术适用于急性-亚急性股腘动脉支架内血栓。
Objective To assess the effectiveness of percutaneous mechanical thrombectomy(PMT) in the treatment of acute and subacute thrombotic occlusions in stent-grafts of femoropopliteal artery.Methods From January 2016 to January 2018,there were 21 patients with acute or subacute thromboses after stent-grafts of femoropopliteal artery.The patients were treated with PMT,16 of which were treated by using the Rotarex mechanical thrombectomy device and 5 of which were treated by using the Angio Jet device.Among them,17 patients were given assisted catheter directed thrombolysis(CDT),percutaneoius transluminal angioplasty(PTA),or stent angioplasty.Results The average lesion length was(15.5±4.9) cm.The immediate technical success rate was 100%(5/5)in the Angio Jet group and 68.8%(11/16) in the Rotarex group.A total of 5 cases with combined CDT obtained a technical success rate of 100%.The residual lesions were treated with PTA in 12 cases and PTA assisted stent angioplasty in 2 cases.The overall clinical success rate was 90.5%(19/21).The median postoperative ankle-branchial index was 0.72(range,0.40-1.20),which was significantly higher than preoperation [0.26(0.00-0.76),Z=-3.640,P=0.001].The complication rate of distal embolization was 28.6%(6/21) and puncture hemorrhage happened in 3 cases(14.3%).There were no complications of perforation,dissection,stent displacement or renal failure.The follow-ups for(13.5±6.1) months in 21 cases showed the primary patency rate of 81.1%(17/21) and the secondary patency rate of 100.0%(21/21) after 6 months.No fatal case was seen.One case(4.8%) suffered from foot gangrene and infection and underwent foot amputation 2 months after operation.Conclusion PMT is a choice for acute and subacute thrombosis of thrombotic femoropopliteal artery stent occlusions.
Objective To assess the effectiveness of percutaneous mechanical thrombectomy(PMT) in the treatment of acute and subacute thrombotic occlusions in stent-grafts of femoropopliteal artery.Methods From January 2016 to January 2018,there were 21 patients with acute or subacute thromboses after stent-grafts of femoropopliteal artery.The patients were treated with PMT,16 of which were treated by using the Rotarex mechanical thrombectomy device and 5 of which were treated by using the Angio Jet device.Among them,17 patients were given assisted catheter directed thrombolysis(CDT),percutaneoius transluminal angioplasty(PTA),or stent angioplasty.Results The average lesion length was(15.5±4.9) cm.The immediate technical success rate was 100%(5/5)in the Angio Jet group and 68.8%(11/16) in the Rotarex group.A total of 5 cases with combined CDT obtained a technical success rate of 100%.The residual lesions were treated with PTA in 12 cases and PTA assisted stent angioplasty in 2 cases.The overall clinical success rate was 90.5%(19/21).The median postoperative ankle-branchial index was 0.72(range,0.40-1.20),which was significantly higher than preoperation [0.26(0.00-0.76),Z=-3.640,P=0.001].The complication rate of distal embolization was 28.6%(6/21) and puncture hemorrhage happened in 3 cases(14.3%).There were no complications of perforation,dissection,stent displacement or renal failure.The follow-ups for(13.5±6.1) months in 21 cases showed the primary patency rate of 81.1%(17/21) and the secondary patency rate of 100.0%(21/21) after 6 months.No fatal case was seen.One case(4.8%) suffered from foot gangrene and infection and underwent foot amputation 2 months after operation.Conclusion PMT is a choice for acute and subacute thrombosis of thrombotic femoropopliteal artery stent occlusions.
引文
1 Schillinger M,Sabeti S,Dick P,et al.Sustained benefit at 2 years of primary femoropopliteal stenting compared with balloon angioplasty with optional stenting.Circulation,2007,115(21):2745-2749.
2 Laird JR,Katzen BT,Scheinert D,et al.Nitinol stent implantation vs.balloon angioplasty for lesions in the superficial femoral and proximal popliteal arteries of patients with claudication:three-year follow-up from the RESILIENT randomized trial.J Endovasc Ther,2012,19(1):1-9.
3王恒振,魏争,刘冰.股动脉支架内再狭窄的腔内治疗进展.中国血管外科杂志(电子版),2016,8(1):93-96.
4庄金满,李选.下肢动脉硬化闭塞症的治疗进展.中国微创外科杂志,2014,14(9):839-843.
5王深明,姚陈.规范下肢动脉硬化闭塞症的血管腔内治疗.中华外科杂志,2016,54(8):564-567.
6 Schrijver AM,de Vries JP,van den Heuvel DA,et al.Long-term outcomes of catheter-directed thrombolysis for acute lower extremity occlusions of native arteries and prosthetic bypass grafts.Ann Vasc Surg,2016,31(2):134-142.
7郭伟,符伟国,陈忠,主译.卢瑟福血管外科学(第7版).下卷.第1版.北京:北京大学医学出版社,2013.1692-1696.
8葛世堂,潘晓琳,张希全,等.机械性血栓抽吸治疗急性下肢动脉栓塞临床效果.介入放射学杂志,2015,24(11):954-956.
9 Kronlage M,Printz I,Vogel B,et al.A comparative study on endovascular treatment of(sub)acute critical limb ischemia:mechanical thrombectomy vs thrombolysis.Drug Des Devel Ther,2017,11(4):1233-1241.
10 Leung DA,Blitz LR,Nelson T,et al.Rheolytic pharmacomechanical thrombectomy for the management of acute limb ischemia:results from the PEARL registry.J Endovasc Ther,2015,22(4):546-557.
11 Borgia F,Di Serafino L,Sannino A,et al.AngioJet rheolytic thrombectomy for acute superficial femoral artery stent or femoropopliteal by-pass thrombosis.Monaldi Arch Chest Dis,2010,74(2):76-81.
12 Wissgott C,Kamusella P,Andresen R.Recanalization of acute and subacute venous and synthetic bypass-graft occlusions with a mechanical rotational catheter.Cardiovasc Intervent Radiol,2013,36(4):936-942.
13 Kilickesmez O,Oguzkurt L.Mechanical thrombectomy with Rotarex system in Buerger’s disease.J Clin Imaging Sci,2015,5(2):14-19.
14 Wissgott C,Kamusella P,Andresen R.Treatment of chronic occlusions of the iliac or femoropopliteal arteries with mechanicalrotational catheters.Rofo,2011,183(10):945-951.
15李宏伟,罗宇东,冯海伦,等.经皮机械血栓清除术治疗下肢动脉狭窄伴血栓形成病变的近期疗效观察.天津医科大学学报,2017,23(5):430-433.
16 Duc SR,Schoch E,Pfyffer M,et al.Recanalization of acute and subacute femoropopliteal artery occlusions with the rotarex catheter:one year follow-up,single center experience.Cardiovasc Intervent Radiol,2005,28(5):603-610.
2 Laird JR,Katzen BT,Scheinert D,et al.Nitinol stent implantation vs.balloon angioplasty for lesions in the superficial femoral and proximal popliteal arteries of patients with claudication:three-year follow-up from the RESILIENT randomized trial.J Endovasc Ther,2012,19(1):1-9.
3王恒振,魏争,刘冰.股动脉支架内再狭窄的腔内治疗进展.中国血管外科杂志(电子版),2016,8(1):93-96.
4庄金满,李选.下肢动脉硬化闭塞症的治疗进展.中国微创外科杂志,2014,14(9):839-843.
5王深明,姚陈.规范下肢动脉硬化闭塞症的血管腔内治疗.中华外科杂志,2016,54(8):564-567.
6 Schrijver AM,de Vries JP,van den Heuvel DA,et al.Long-term outcomes of catheter-directed thrombolysis for acute lower extremity occlusions of native arteries and prosthetic bypass grafts.Ann Vasc Surg,2016,31(2):134-142.
7郭伟,符伟国,陈忠,主译.卢瑟福血管外科学(第7版).下卷.第1版.北京:北京大学医学出版社,2013.1692-1696.
8葛世堂,潘晓琳,张希全,等.机械性血栓抽吸治疗急性下肢动脉栓塞临床效果.介入放射学杂志,2015,24(11):954-956.
9 Kronlage M,Printz I,Vogel B,et al.A comparative study on endovascular treatment of(sub)acute critical limb ischemia:mechanical thrombectomy vs thrombolysis.Drug Des Devel Ther,2017,11(4):1233-1241.
10 Leung DA,Blitz LR,Nelson T,et al.Rheolytic pharmacomechanical thrombectomy for the management of acute limb ischemia:results from the PEARL registry.J Endovasc Ther,2015,22(4):546-557.
11 Borgia F,Di Serafino L,Sannino A,et al.AngioJet rheolytic thrombectomy for acute superficial femoral artery stent or femoropopliteal by-pass thrombosis.Monaldi Arch Chest Dis,2010,74(2):76-81.
12 Wissgott C,Kamusella P,Andresen R.Recanalization of acute and subacute venous and synthetic bypass-graft occlusions with a mechanical rotational catheter.Cardiovasc Intervent Radiol,2013,36(4):936-942.
13 Kilickesmez O,Oguzkurt L.Mechanical thrombectomy with Rotarex system in Buerger’s disease.J Clin Imaging Sci,2015,5(2):14-19.
14 Wissgott C,Kamusella P,Andresen R.Treatment of chronic occlusions of the iliac or femoropopliteal arteries with mechanicalrotational catheters.Rofo,2011,183(10):945-951.
15李宏伟,罗宇东,冯海伦,等.经皮机械血栓清除术治疗下肢动脉狭窄伴血栓形成病变的近期疗效观察.天津医科大学学报,2017,23(5):430-433.
16 Duc SR,Schoch E,Pfyffer M,et al.Recanalization of acute and subacute femoropopliteal artery occlusions with the rotarex catheter:one year follow-up,single center experience.Cardiovasc Intervent Radiol,2005,28(5):603-610.