【摘要】 目的评估Rotarex经皮机械性清除血栓(PMT)治疗下肢动脉闭塞所致急性下肢缺血的近中期效果,分析不同病因急性下肢缺血对保肢率的影响。方法回顾性分析2014年10月至2017年6月两医学中心采用Rotarex PMT术治疗的89例(96条患肢)急性下肢缺血患者临床资料。其中男51例(56肢),女38例(40肢),平均年龄(64.3±7.2)(37～96)岁。96条患肢中急性动脉栓塞31肢,急性动脉血栓形成36肢,移植物血栓形成29肢。主要研究终点为保肢率,以病因学作亚组分析;次要研究终点包括靶病变通畅率、大出血并发症、术后30 d内死亡率和再手术率。结果术后大出血并发症发生率为3.4%(3/89)。术后30 d内死亡率为4.5%(4/89)。术后1年、2年总靶病变一期通畅率分别为77%、67%,二期通畅率>80%。术后1年、2年总保肢率分别为83.4%、71.8%。亚组分析显示急性动脉栓塞组患者术后2年保肢率为90.3%,显著高于急性动脉血栓形成组患者(65.2%,P=0.047;HR=4.2,95%CI=1.1～11.4)和移植物血栓形成组患者(60.1%,P=0.037;HR=4.9,95%CI=1.2～15.1)。移植物血栓形成组、急性动脉血栓形成组、急性动脉栓塞组再手术率分别为20.1%(6/29)、13.9%(5/36)、3.2%(1/31)。结论 Rotarex PMT术治疗急性下肢缺血安全、有效,尤其是对急性动脉栓塞患者。更多还原

【Abstract】 Objective To evaluate the short-to-mid-term outcomes of percutaneous mechanical thrombectomy(PMT) with Rotarex device in treating acute lower limb ischemia, and to analyze the influence of acute limb ischemia caused by different etiologies on the limb salvage rate. Methods The clinical data of89 patients with acute lower limb ischemia(96 diseased limbs in total), who received Rotarex PMT during the period from October 2014 to June 2017 at two medical centers, were retrospectively analyzed. The patients included 51 males(56 diseased limbs) and 38 females(40 diseased limbs), the average age was(64.3±7.2)years(37-96 years). Of 96 diseased limbs, acute arterial embolism was seen in 31, acute arterial thrombosis in 36, and graft thrombosis in 29. The main endpoint of the study was limb salvage rate, and the subgroups were analyzed by etiological factors. The secondary endpoints of the study included the patency rate of target vessels, the complications of massive hemorrhage, and mortality and the re-operation rate within 30 days after Rotarex PMT. Results The incidence of postoperative massive hemorrhage was 3.4%(3/89). The mortality within 30 days after PMT was 4.5%(4/89). The total one-year and 2-year primary patency rates of target vessels were 77% and 67% respectively, and the secondary patency rate was >80%. The total limb salvage rates in one year and 2 years after PMT were 83.4% and 71.8% respectively. Subgroup analysis showed that two years after PMT the limb salvage rate in the patients of acute arterial embolism group was90.3%, which was significantly higher than 65.2% in the patients of acute arterial thrombosis group(P=0.047; HR=4.2, 95%CI=1.1-11.4) as well as higher than 60.1% in the patients of graft thrombosis group(P=0.037; HR=4.9, 95%CI=1.2-15.1). The re-operation rates in graft thrombosis group, acute arterial thrombosis group and acute arterial embolism group were 20.1%(6/29), 13.9%(5/36) and 3.2%(1/31)respectively. Conclusion For the treatment of acute lower limb ischemia, Rotarex PMT is safe and effective,especially for patients with acute arterial embolism.更多还原