【摘要】 目的总结患者仰卧体位下经股腘动脉双向入路开通股浅动脉慢性完全闭塞(CTO)病变的经验。方法从2011年5月—2012年5月对17例股浅动脉CTO病变的患者取仰卧位下行经腘动脉逆向开通术,平均CTO病变长度为(97.4±3.8)mm,所有患者术前均表现为患肢间歇性跛行,Rutherford分级均为3级以上。手术先行对侧股总动脉穿刺,当顺行开通失败时行经腘动脉逆向开通,在数字减影血管造影(DSA)路径图或X线透视下以长度为7cm的21G微穿刺针进行腘动脉穿刺,一旦导丝逆行通过闭塞段进入真腔后,再顺行置入球囊预扩张、释放支架、后扩张。腘动脉穿刺点以鱼精蛋白中和肝素,腘动脉内置入直径5mm的球囊行动脉腔内血流暂时阻断,并予压力袖带加压[压力高于收缩压10~20 mmHg(1 mmHg=0.133kPa),10min]等方式止血处理。结果本组患者均于仰卧位下通过DSA路径图或X线透视下穿刺腘动脉,穿刺成功率为100%。其中10例患者行逆向真腔开通,7例患者因逆向导丝进入内膜下无法回到真腔而采用内膜下技术开通。17例患者共置入支架51枚。无1例患者发生穿刺点出血和血肿、假性动脉瘤、动静脉瘘、夹层等并发症。踝肱指数由术前的0.4±0.2上升至术后的0.8±0.1。所有患者的患肢间跛症状均明显改善。术后随访(5.1±2.4)个月。术后1个月,超声检查见所有患者均无支架内再狭窄;术后12个月,超声检查发现7例患者发生支架内再狭窄,其中3例患者分别于术后9、10、12个月再次出现间歇性跛行,经下肢动脉造影检查发现支架内再狭窄程度均>50%,予以球囊扩张后症状均缓解。结论患者取仰卧位行经腘动脉逆向开通术是安全、有效的,对于自股浅动脉起始端就完全闭塞、闭塞段位于股浅动脉中远段或有较大的侧支从股浅动脉闭塞段发出的病变,若顺行开通失败,可行经腘动脉入路逆向开通进一步治疗。更多还原

【Abstract】 Objective To report the experience of recanalization for chronic total occlusion(CTO)of superficial femoral artery(SFA)by a dual femoral-popliteal approach in supine position.Methods From May 2011to May 2012,17patients with intermittent claudication and chronic SFA occlusion(mean length[97.4± 3.8]mm)underwent percutaneous recanalization from a retrograde popliteal access.The common femoral artery was punctured with retrograde contralateral approach,then the popliteal artery was punctured using a 21Gneedle under fluoroscopic guidance with a roadmap technique.Once the SFA was recanalized,the procedure was completed with angioplasty and stenting from the femoral approach.At the end of the procedure,hemostasis at the popliteal access was obtained using protamine to reverse heparine and balloon inflate intra-arterial and using cuff to compress outside(10-20mmHg[1mmHg=0.133kPa]higher than systolic blood pressure,10min).Results The puncture of the popliteal artery and SFA recanalization were achieved in all cases.Endoluminal recanalization was successfully performed in 10patients from the popliteal access and in the other 7patients through the subintimal space.A total of 51 stents were implanted.No hemorrhage,hematomas,pseudoaneurysm,arteriovenous fistulas arterial sandwich were found in the popliteal region.Ankle-brachial index was 0.4± 0.2before surgery and 0.8±0.1after surgery.The symptoms,such as intermittent claudication were decreased.The average duration of follow-up was(5.1±2.4)months.In-stent restenosis was not found one month after surgery and occurred in 7patients 12months after surgery by B ultrasound.Intermittent claudication occurred in 3 patients 9,10and 12months postoperatively.The arteriography for artery of lower extremity showed that in-stent restenosis was above 50% and alleviated after treatment with balloon dilatation.Conclusion The retrograde popliteal approach with supine position;safe and effective,and can be considered as the first choice for SFA recanalization.更多还原