CAJ | 학술논문

目的探讨股总动脉(common femoral artery,CFA)内膜切除联合股浅动脉(superficial femoral artery,SFA)支架置入治疗下肢动脉多节段狭窄闭塞的有效性和安全性.方法 2006年3月至2010年5月对累及CFA和股深动脉(profunda femoris artery,PFA)及SFA起始处的股腘动脉多节段狭窄闭塞病变的86例患者(92条肢体)同期采用CFA内膜切除、大隐静脉补片成形和SFA支架置入的复合术式治疗.术后每6个月随访患者的临床状况,踝肱指数(ankle-brachial index,ABI)和彩色多普勒超声(color duplex ultrasonography,CDU),术后第12、24、36个月进行下肢动脉CTA或DSA检查.结果手术均取得了成功,ABI由术前的0.31 ±0.24增至0.82±0.36 (P=0.000).围手术期无死亡和严重截肢病例.随访时间1 010 ～2064 d,平均(1 486±472)d.随访期间,4例死于心肌梗死、脑梗死、肺部感染,4例失访;18例(19.6％)发生再狭窄,其中14例位于支架内,4例位于支架远端;12例再狭窄者接受了再次治疗,其中单纯球囊扩张4例,再次支架置入5例,动脉旁路手术1例,截肢2例.SFA支架12、24、36个月的初次通畅率分别为90.2％,74.6％和58.4％;二次通畅率分别为92.7％、80.8％和70.2％.结论对于累及股总动脉的下肢动脉多节段狭窄闭塞病变,股总动脉内膜切除联合股浅动脉支架植入是一个安全、微创、有效的治疗方式.
목적 탐토고총동맥(common femoral artery,CFA)내막절제연합고천동맥(superficial femoral artery,SFA)지가치입치료하지동맥다절단협착폐새적유효성화안전성.방법 2006년3월지2010년5월대루급CFA화고심동맥(profunda femoris artery,PFA)급SFA기시처적고객동맥다절단협착폐새병변적86례환자(92조지체)동기채용CFA내막절제、대은정맥보편성형화SFA지가치입적복합술식치료.술후매6개월수방환자적림상상황,과굉지수(ankle-brachial index,ABI)화채색다보륵초성(color duplex ultrasonography,CDU),술후제12、24、36개월진행하지동맥CTA혹DSA검사.결과 수술균취득료성공,ABI유술전적0.31 ±0.24증지0.82±0.36 (P=0.000).위수술기무사망화엄중절지병례.수방시간1 010 ～2064 d,평균(1 486±472)d.수방기간,4례사우심기경사、뇌경사、폐부감염,4례실방;18례(19.6％)발생재협착,기중14례위우지가내,4례위우지가원단;12례재협착자접수료재차치료,기중단순구낭확장4례,재차지가치입5례,동맥방로수술1례,절지2례.SFA지가12、24、36개월적초차통창솔분별위90.2％,74.6％화58.4％;이차통창솔분별위92.7％、80.8％화70.2％.결론 대우루급고총동맥적하지동맥다절단협착폐새병변,고총동맥내막절제연합고천동맥지가식입시일개안전、미창、유효적치료방식.
Objective To investigate the efficacy and safety of combined common femoral artery (CFA) endarterectomy with superficial femoral artery (SFA) stenting in patients with complex multifocal arterial steno-obstructive lesions of the lower extremities.Methods From March 2006 to May 2010,92 lower limbs in 86 patients with multilevel peripheral arterial steno-occlusive disease,involving SFA as well as CFA and profunda femoris artery (PFA) orifice,were treated by combined open surgery with endovascular therapy,such as SFA stenting as an adjunct to CFA endarterectomy and patch angioplasty with the great saphenous vein.During follow-up,clinical status assessment,ankle-brachial index (ABI) test,and duplex Doppler ultrasound were administered every 6 months,and computed tomography angiography (CTA) or digital subtraction angiography (DSA) was performed at 12,24 and 36 months after discharge.Results Procedures were successful in all patients.Average ABI increased from 0.31 ± 0.24 to 0.82 ± 0.36 (P =0.000).There was no perioperative death and major limb amputations.The mean duration of follow-up was 1 486 ± 472 days (range,1 010-2 064 days).During follow-up,4 patients died of myocardial or cerebral infarction or pneumonia,and 4 were lost to follow-up.There were 18 cases (19.6％) of restenosis,with 14 in-stent and 4 near the distal end of the stent.Reinterventions were performed in 12 cases,including 4 balloon angioplasty,5 restenting,1 bypass and 2 major limb amputations.The primary patency rates were 90.2％,74.6％ and 58.4％ at 12,24,and 36 months,respectively,while the secondary patency rates were 92.7％、80.8％ and 70.2％ at 12,24,and 36 months,respectively.Conclusions Combined CFA endarterectomy with SFA stenting offer a safe,less invasive and effective treatment to patients with chronic lower extremity ischemia due to complex multifocal peripheral artery disease.