中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2011年
10期
960-963
,共4页
李京雨%刘涛%路军良%徐力扬
李京雨%劉濤%路軍良%徐力颺
리경우%류도%로군량%서력양
下肢%动脉硬化闭塞症%内膜下成形术
下肢%動脈硬化閉塞癥%內膜下成形術
하지%동맥경화폐새증%내막하성형술
Lower extremity%Arteriosclerosis obliterans%Subintimal angioplasty
目的 探讨根据下肢动脉硬化闭塞症( ASO)复杂病变的影像特征进行个体化介入治疗的方法和效果.方法 回顾性分析78例下肢动脉ASO复杂病变患者的临床、影像和随访资料.68例为泛大西洋学会共识(TASC)ⅡC或D级病变,10例为影像特征较复杂的TASCⅡB级病变;共103处病变.临床表现Fontaine stageⅢ、Ⅳ型和较重的Ⅱ型.在具有较好的流出道血管及适用的穿刺入路基本条件下,将长段闭塞、平齐闭塞、多发闭塞、腘动脉闭塞、膝以下动脉闭塞以及主髂动脉闭塞等复杂病变均视为适应证,针对病变影像特点灵活选择穿刺入路,应用内膜下再通技术顺行开通或双向开通闭塞段.对术后踝臂指数(ABI)行t检验.结果 73例患者再通治疗获技术成功,未发生重要并发症.再通后肢体缺血症状立即减轻,平均ABI由术前0.45±0.07增加至0.76±0.11(t=- 19.78,P< 0.01).5例再通失败者未导致症状恶化.47例随访6~12个月,22例未见肢体缺血症状复发.结论 根据影像特征指导选择介入治疗方法能避免TASC分型指导适应证选择的局限性,使更多ASO病变通过非手术方法得到有效治疗.
目的 探討根據下肢動脈硬化閉塞癥( ASO)複雜病變的影像特徵進行箇體化介入治療的方法和效果.方法 迴顧性分析78例下肢動脈ASO複雜病變患者的臨床、影像和隨訪資料.68例為汎大西洋學會共識(TASC)ⅡC或D級病變,10例為影像特徵較複雜的TASCⅡB級病變;共103處病變.臨床錶現Fontaine stageⅢ、Ⅳ型和較重的Ⅱ型.在具有較好的流齣道血管及適用的穿刺入路基本條件下,將長段閉塞、平齊閉塞、多髮閉塞、腘動脈閉塞、膝以下動脈閉塞以及主髂動脈閉塞等複雜病變均視為適應證,針對病變影像特點靈活選擇穿刺入路,應用內膜下再通技術順行開通或雙嚮開通閉塞段.對術後踝臂指數(ABI)行t檢驗.結果 73例患者再通治療穫技術成功,未髮生重要併髮癥.再通後肢體缺血癥狀立即減輕,平均ABI由術前0.45±0.07增加至0.76±0.11(t=- 19.78,P< 0.01).5例再通失敗者未導緻癥狀噁化.47例隨訪6~12箇月,22例未見肢體缺血癥狀複髮.結論 根據影像特徵指導選擇介入治療方法能避免TASC分型指導適應證選擇的跼限性,使更多ASO病變通過非手術方法得到有效治療.
목적 탐토근거하지동맥경화폐새증( ASO)복잡병변적영상특정진행개체화개입치료적방법화효과.방법 회고성분석78례하지동맥ASO복잡병변환자적림상、영상화수방자료.68례위범대서양학회공식(TASC)ⅡC혹D급병변,10례위영상특정교복잡적TASCⅡB급병변;공103처병변.림상표현Fontaine stageⅢ、Ⅳ형화교중적Ⅱ형.재구유교호적류출도혈관급괄용적천자입로기본조건하,장장단폐새、평제폐새、다발폐새、객동맥폐새、슬이하동맥폐새이급주가동맥폐새등복잡병변균시위괄응증,침대병변영상특점령활선택천자입로,응용내막하재통기술순행개통혹쌍향개통폐새단.대술후과비지수(ABI)행t검험.결과 73례환자재통치료획기술성공,미발생중요병발증.재통후지체결혈증상립즉감경,평균ABI유술전0.45±0.07증가지0.76±0.11(t=- 19.78,P< 0.01).5례재통실패자미도치증상악화.47례수방6~12개월,22례미견지체결혈증상복발.결론 근거영상특정지도선택개입치료방법능피면TASC분형지도괄응증선택적국한성,사경다ASO병변통과비수술방법득도유효치료.
Objective To explore the methods and effectiveness of interventional revascularization of complex arteriosclerosis obliterans (ASO) of lower extremity arteries according to their imaging characteristics.Methods Seventy-eight patients with lower extremity ASO complex lesions classified as TASC Ⅱ C/D ( n =68 ) and TASC Ⅱ B ( n =10) underwent antigrade or combined antigrade-retrograde subintimal angioplasty.Their clinical situations were Fontaine stage Ⅲ/Ⅳ or severe stage Ⅱ.All the long occlusion,flush occlusion,multiple occlusion,popliteal artery occlusion,below knee artery occlusion and aortoiliac artery occlusion were identified as complex lesion imaging features and as the indication of interventional treatment if only there were visible outflow vessels and suitable puncture site.Statistical analysis was used to compare ankle-brachial index (ABI) pretreatment and post-treatment by t test.Results Successful revascularization was achieved in 73 patients technically.No obvious complications occurred.Ischemia symptoms improved quickly after accomplishment of recanalization.Average ABI increased from 0.45 ±0.07 to 0.76 ±0.11 after the treatment(t =- 19.78,P <0.01 ).Symptoms in 5 patients who failed to get arterial recanalization were stable.Follow up of 6 to 12 months in 47 patients showed stable improvement in 22 of them.Conclusion It is more practical to choose and expand application of interventional treatment for complex ASO according to imaging characteristics of lesions than according to TASC classification.