CAJ | 학술논문

目的探讨远端动脉逆行穿刺治疗下肢动脉慢性完全闭塞性(CTO)病变的安全性和有效性.方法 54例下肢动脉粥样硬化闭塞症患者,经顺行入路无法进入流出道真腔,同期采取逆行穿刺病变远端动脉真腔建立第二入路,分析其病变的开通率.患者中行足背动脉穿刺27例、胫后动脉穿刺17例、胫前动脉近端穿刺5例、股浅动脉远端穿刺5例.观察远端动脉逆行穿刺重建血运的成功率、并发症发生率、6个月保肢率及肱/踝指数( ABI).治疗前后ABI比较采用配对t检验.结果 54例患者中双入路技术重建血运的成功率为98.2％( 53/54),穿刺次数平均为(6±2)次/例(第一入路平均2次/例,第二入路平均4次/例).平均治疗时间为(167±52) min/例.3例出现并发症,2例术中第二入路处动脉闭塞、1例术中出现第二入路处血肿.术后6个月ABI由术前0.44±0.13升至0.69±0.15,差异有统计学意义(t=3.179,P＜0.05).保肢率为100％.结论对于因下肢动脉粥样硬化导致的慢性完全闭塞性病变,如经顺行入路无法进入流出道真腔,在病变解剖允许的前提下,可采取动脉远端逆行穿刺提高重建血运的成功率,其并发症率低,初期保肢率高.
목적 탐토원단동맥역행천자치료하지동맥만성완전폐새성(CTO)병변적안전성화유효성.방법 54례하지동맥죽양경화폐새증환자,경순행입로무법진입류출도진강,동기채취역행천자병변원단동맥진강건립제이입로,분석기병변적개통솔.환자중행족배동맥천자27례、경후동맥천자17례、경전동맥근단천자5례、고천동맥원단천자5례.관찰원단동맥역행천자중건혈운적성공솔、병발증발생솔、6개월보지솔급굉/과지수( ABI).치료전후ABI비교채용배대t검험.결과 54례환자중쌍입로기술중건혈운적성공솔위98.2％( 53/54),천자차수평균위(6±2)차/례(제일입로평균2차/례,제이입로평균4차/례).평균치료시간위(167±52) min/례.3례출현병발증,2례술중제이입로처동맥폐새、1례술중출현제이입로처혈종.술후6개월ABI유술전0.44±0.13승지0.69±0.15,차이유통계학의의(t=3.179,P＜0.05).보지솔위100％.결론 대우인하지동맥죽양경화도치적만성완전폐새성병변,여경순행입로무법진입류출도진강,재병변해부윤허적전제하,가채취동맥원단역행천자제고중건혈운적성공솔,기병발증솔저,초기보지솔고.
Objective To estimate the security and effectiveness of double access technique to treat chronic total occlusion in lower extremity artery. Method Fifty four patients,who had lower limb arteriosclerosis and accepted failed endovascular treatment because of unable to reenter true lumen through antegrade access,were treated immediately in double access style to recanalize occluded artery (including 27 patients of dorsalis pedis artery puncture,17 patients of posterior tibial artery punctrue,5 patients of proximal anterior tibial artery puncture and 5 patients of distal superficial femoral artery puncture). Evaluate the revascularization rate,complication rate and 6-month limb salvage rate of double access technique,t test was used to compare the ABI.Results Revascularization rate was 98.2％ (53/54),average puncture frequency of every case was 6 ( the first access was 2 in every patient,the second access was 4 in every patient ),average treatment time was 167 minutes,complication rate was 5.6％ (3/54),2 patients were occlusion in puncture segment of the second access,1 patient was hematoma in the second access point. 6-month ABI after intervention increased from 0.44 ±0.13 to 0.69 ±0.15,6-month limb salvage rate was 100％. Conclusion For chronic total occlusion,double access is a feasible technique to deal with unable to reenter true lumen throughantegrade access,the complication rate is low,the primary limb salvage rate is relatively high.