CAJ | 학술논문

目的探讨下肢动脉硬化闭塞症腔内治疗的临床疗效.方法回顾性分析山西省人民医院血管外科从2010年7月至2012年7月行腔内治疗的下肢动脉硬化闭塞症患者34例(43条肢体),其中Fontaine分期为Ⅱb期16例,Ⅲ期10例,Ⅳ期8例；泛大西洋协作组织2007年标准分级A级4例,B级8例,C级9例,D级13例.全部患者行CT动脉成像或数字键影血管造影检查后给予腔内治疗,全部患者的病变动脉均行经皮穿刺腔内血管成形加支架植入术,其中9例患者(9条肢体)行股动脉内膜切除联合下肢腔内治疗.结果 34例患者技术成功率为100％,1例髂动脉闭塞患者腔内治疗中出现髂动脉破裂,1例患者出现远端动脉穿孔,1例患者术后1周缺血无改善而截肢,1例患者术后3周支架内急性血栓形成,1例患者术后4周因肢体远端流出道不畅而致截肢,但截至平面降低.30例患者(38条肢体)平均随访13.3个月,术后6个月3条肢体出现闭塞；12个月4条肢体出现闭塞,24个月4条肢体出现闭塞.结论腔内治疗的近期效果良好.在腔内治疗过程中要注意特殊问题的处理,以防严重并发症并尽可能提高近、远期通畅率.
목적 탐토하지동맥경화폐새증강내치료적림상료효.방법 회고성분석산서성인민의원혈관외과종2010년7월지2012년7월행강내치료적하지동맥경화폐새증환자34례(43조지체),기중Fontaine분기위Ⅱb기16례,Ⅲ기10례,Ⅳ기8례；범대서양협작조직2007년표준분급A급4례,B급8례,C급9례,D급13례.전부환자행CT동맥성상혹수자건영혈관조영검사후급여강내치료,전부환자적병변동맥균행경피천자강내혈관성형가지가식입술,기중9례환자(9조지체)행고동맥내막절제연합하지강내치료.결과 34례환자기술성공솔위100％,1례가동맥폐새환자강내치료중출현가동맥파렬,1례환자출현원단동맥천공,1례환자술후1주결혈무개선이절지,1례환자술후3주지가내급성혈전형성,1례환자술후4주인지체원단류출도불창이치절지,단절지평면강저.30례환자(38조지체)평균수방13.3개월,술후6개월3조지체출현폐새；12개월4조지체출현폐새,24개월4조지체출현폐새.결론 강내치료적근기효과량호.재강내치료과정중요주의특수문제적처리,이방엄중병발증병진가능제고근、원기통창솔.
Objective To explore the clinical efficacy of endovascular treatment for lower extremity arteriosclerosis obliterans.Methods A total of 34 patients (43 limbs) with lower extremity arteriosclerosis obliterans undergoing endovascular treatment from July 2010 to July 2012 were analyzed.The cohort had Fontaine stage Ⅱ b (n =16),Fontaine stage Ⅲ (n =10) and Fontaine stage Ⅲ (n =8).Among them,the lesions were of TASC ⅡA (n=4),TASC Ⅱb (n=8),TASC ⅡC (n=9) and TASC ⅡD (n=13).All patients underwent percutaneous transluminal angioplasty (PTA) plus stents after computed tomographic angiography (CTA) or digital subtraction angiography (DSA).And 9 patients underwent femoral endarterectomy associated with endovascular treatment.Results The success rate of this technique was 100％.One iliac artery ruptured during endovascular surgery.One patient suffered intraoperatively from arterial perforation.One patient was amputated one week later.One patient had in-stent thrombosis at Week 3 post-treatment.One patient was amputated at Week 4 after endovascular treatment.Thirty patients (38 limbs) were followed up for 13.3 months.During the follow-up,3,4 and 4 limbs became occluded at Month 6,12 and 24 post-treatment respectively.Conclusion Endovascular treatment has an excellent early patency rate.Special issues should be properly handled during endovascular treatment.