CAJ | 학술논문

目的分析双向内膜下血管成形术(subintimal arterial flossing with antegrade-retrograde intervention,SAFARI)的技术要点,并评估该技术在长段下肢动脉闭塞人群中的应用. 方法 2012年5月至2013年10月应用SAFARI技术对25例长段下肢动脉闭塞患者进行介入治疗,其中男22例,女3例,年龄55～ 85岁,平均(69±9)岁.临床表现所有患者均有间歇性跛行,跛行距离均＜200 m,4例有静息痛,合并足趾坏疽3例.比较手术前、后患者症状及踝肱指数的变化.结果本组共25例患者均获得随访,随访时间3～12个月,平均随访(6±3)个月.1例患者术后6个月出现股浅动脉支架内再闭塞.所有患者术后缺血引起的症状消失或明显改善,无严重围手术期并发症.复查ABI值平均为0.90±0.15,与术前平均值0.40±0.28比较,差异有统计学意义(t=5.28,P＜0.05).结论双向内膜下血管成形术可以作为下肢动脉闭塞性病变顺行导丝无法开通时的一种补救方法,可明显提高介入手术成功率.
목적 분석쌍향내막하혈관성형술(subintimal arterial flossing with antegrade-retrograde intervention,SAFARI)적기술요점,병평고해기술재장단하지동맥폐새인군중적응용. 방법 2012년5월지2013년10월응용SAFARI기술대25례장단하지동맥폐새환자진행개입치료,기중남22례,녀3례,년령55～ 85세,평균(69±9)세.림상표현소유환자균유간헐성파행,파행거리균＜200 m,4례유정식통,합병족지배저3례.비교수술전、후환자증상급과굉지수적변화.결과 본조공25례환자균획득수방,수방시간3～12개월,평균수방(6±3)개월.1례환자술후6개월출현고천동맥지가내재폐새.소유환자술후결혈인기적증상소실혹명현개선,무엄중위수술기병발증.복사ABI치평균위0.90±0.15,여술전평균치0.40±0.28비교,차이유통계학의의(t=5.28,P＜0.05).결론 쌍향내막하혈관성형술가이작위하지동맥폐새성병변순행도사무법개통시적일충보구방법,가명현제고개입수술성공솔.
Objective To review the technical details regarding subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) and evaluate its role in long-segment occlusion of the lower extremity artery.Methods Between May 2012 and Oct 2013,25 patients underwent endovascular recanalization with SAFARI technique.There were 22 male patients and 3 female patients,aged between 55 to 85 years (mean:69 ± 9 years).All patients had intermittent claudication,with distance less than 200 meters,in whom 4 patients had rest pain,3 with gangrene of the toes.The post-treatment and pre-treatment ankle-brachial index (ABI) and symptoms were analyzed.Results In this group,all 25 patients were followed up for 3 to 12 months(mean:5.9 months).One patient had re-occlusion of femoral artery stenting after 6 months.After the treatment,the ischemic symptoms were markedly improved or even disappeared.No severe perioperative complications occurred.The ABI recheck results were 0.90 ± 0.15,with significance compared with that before surgery (mean 0.40 ± 0.28,t =5.28,P ＜ 0.05).Conclusions SAFARI can be used as a remedy to antegrade technique when the wire could not pass the conclusive lesion,significantly improving the success rate of interventional treatment.