【作者】 马新刚；

【导师】 于振海；

【作者基本信息】 山东大学 ， 外科学， 2010， 硕士

【摘要】 背景：下肢动脉硬化闭塞症由于动脉管腔狭窄、闭塞,引起慢性下肢慢性缺血。随着老龄人口逐渐增多,发病率逐渐升高,病变后期有较高的致残率。传统手术治疗方法创伤大,并发症发生率和病死率高。腔内治疗具有微创、可重复性的特点,死亡率及并发症发生率明显降低,随着腔内治疗的发展,腔内治疗得到越来越多的应用,具有良好的发展前景。目的：讨论与分析下肢动脉缺血性疾病的腔内治疗方法,提高下肢动脉硬化闭塞症的治疗效果。方法：回顾性分析山东大学附属千佛山医院自2005年6月至2007年6月进行腔内治疗的16例下肢动脉硬化闭塞症的临床资料。男性14例,女性2例。年龄51-75岁,平均年龄62.4岁。按病变的Fontaine分期,Ⅰla期2例,Ⅰlb期12例,Ⅲ期1例,Ⅳ期1例。TASCⅡ分型：A型2例,B型9例,C型3例,D型病变2例。术前踝肱指数(ABI)检查,在0-0.86之间,平均0.43。CTA显示：髂动脉狭窄6例,其中1例合并股浅动脉闭塞,1例合并股浅动脉狭窄；单纯股浅动脉狭窄6例,闭塞3例,其中1例为双侧狭窄；膝以下动脉节段性闭塞1例。病变共19处,髂动脉6处,股浅动脉12处,膝下动脉1处。需处理病变共19处,其中1处病变未开通,10处病变单纯球囊扩张,8处病变置入支架。结果：骼动脉开通率与技术成功率100%(6／6),术后1年、2年通畅率分别为83.3%(5／6)、83.3%(5／6)。股动脉开通率91.7%(11／12)；技术成功率100%.(11／11),术后1年、2年通畅率分别为81.8%(9／11)、72.7%(8／11)。膝下动脉1例,治疗后溃疡逐渐愈合。术后踝肱指数均提高0.15以上。结论：主骼动脉的腔内治疗近、远期效果满意,可作为首选治疗方法；股胭动脉腔内治疗对于高危不适合手术患者可作为首选；膝下动脉应首选腔内治疗。更多还原

【Abstract】 Background:Arteriosclerosis obliterans cause chronic lower limb chronic ischemia because of stenosis and occlusion of the lower limb artery. The mobidity increased with the aging population gradually increased. arteriosclerosis obliterans cause high disability rate in the end. Traditional surgical methods have high complication rate and mortality. Endovascular treatment have characteristics of minimally invasive, can be repeated operation, and lower mortality and complication rates, endovascular treatment used more and more in clinical, with good prospects for development.ObjectiveDiscussion and analysis of lower limb ischemic disease of endovascular therapy. And improve therapeutic effect of Peripheral arterial disease.MethodsWe conducted a retrospective analysis on 16 Patients of atherosclerotic occlusive disease with clinical data. Underwent endovascular treatment from June 2005 to June 2007 in the Qianfoshan Hospital of Shandong University.14 male and 2 female Patients, a mean age of 62.4 years(range 51-85 years). According to the Foniaines tages, there were 2 stage lla Patients,12 stage l1b Patients,1 stage 111 patient(rest pain),1 stage IV patient(Foot ulcer). According to TASCII classification, there were 2 type A Patients,9 type B Patients,3 type C Patients,2 type D Patients. Preoperative ankle-brachial index (ABI) check between 0-0.86, with an average of 0.43. CTA Show: iliac artery stenosis in 6 cases, femoral artery occlusion inl case, and femoral artery stenosis inl; superficial femoral artery stenosis in 6 cases, occlusion in 3 cases,1 patient had bilateral stenosis; segmental occlusion below knee artery in 1 case.A total of 19 lesions to be treatmented, one lesion not to be opened,19 lesions underwent balloon dilatation and 8 lesions were performed balloon dilatation and stent placement.ResultsIn the iliac artery, the acute patency rate and technical success rate was 100%.The 1-and 2-year Patency was 83.3%、83.3%.In the femoralpopliteal artery,the acute patency rate was 91.7%, technical success rate was 100%, the Patency at 1 and 2 year were 81.8% and 72.7%, Below-knee artery occlusion in 1 case, Ulcers gradually healed after treatmented.Anklebrachial index of postoperation Increased more than o.15.ConclusionsEndovascular treatment for iliac arterial occlusived disease can be used as the first choice because of Satisfactory short-term and long-term outcome;The endovascular treatment can be use as first choice for high-risk patiens for femoral arterial occlusive disease;Endovascular treatment is prefered in patients with belowe-knee artery occlusion.更多还原