下肢动脉疾病专题研究(Monographic Study of Arterial Diseases of The Lower Extremities)

下肢动脉硬化闭塞症腔内治疗后支架内再狭窄的治疗

Published at: 2015年第24卷第12期

吴元兵 1 , 朱云峰 1 , 葛红卫 1 , 朱永斌 1 , 陈诚 1 , 王鑫 1
1 苏州大学附属第三医院 血管外科,江苏 常州 213003
通讯作者 元兵 吴 Email: yuanbingwu@sina.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.12.010
基金:

摘要

目的:探讨下肢动脉硬化闭塞症(ASO)腔内治疗后支架内再狭窄的治疗体会。 方法:回顾性分析2012 年6 月至2014 年12 月收治的支架内再狭窄的31 例下肢ASO 患者(49 条肢体) 资料,其中狭窄病变37 条肢体,闭塞病变12 条肢体;病变长度8.5~35 cm,平均(25.2±7.5)cm。 结果:所有患者均接受腔内治疗,包括单纯球囊扩张成形术35 例,球囊扩张后导管溶栓术3 例,球囊 扩张后支架植入术3 例,导管溶栓后球囊扩张术7 例,斑块旋切术1 例。术后所有患者症状均不同程 度缓解,平均踝肱指数较术前明显升高(P<0.05)。28 例获得随访3~32 个月,平均(16.2±5.8)个月, 期间出现再狭窄6 例(21.4%),均再次行球囊扩张成形术,无截肢及死亡病例。 结论:结合其他腔内疗法,球囊扩张术治疗下肢动脉支架内再狭窄疗效满意


Management of in-stent restenosis in lower limb arteriosclerosis obliterans after endovascular treatment

Abstract

Objective: To review the experience in management of in-stent restenosis in lower limb arteriosclerosis obliterans (ASO) after endovascular treatment. Methods: The clinical data of 31 lower limb ASO patients (49 limbs) with post-interventional in-stent restenosis treated from June 2012 to December 2014 were analyzed retrospectively. The lesions included restricture in 37 limbs and with reocclusion in 12 limbs, and the length of lesions ranged from 8.5 to 35 cm with an average of 25.2 cm. Results: All patients received endovascular treatment. The treatment modalities included lone balloon dilation angioplasty in 35 limbs, catheter-directed thrombolysis after balloon dilation in 3 limbs, balloon dilation with additional stent implantation in 3 limbs, catheter-directed thrombolysis prior to balloon dilation in 7 limbs, and SilverHawk atherectomy in one limb. After operation, varying degrees of improvement of symptoms occurred in all cases, and the average ankle-brachial index was increased significantly compared with preoperative value (P<0.05). Twenty-eight patients were followed up for 3 to 32 months with an average of 16.2 months, during which period, restenosis recurred in 6 cases (21.4%), and all of them had a repeat balloon dilation angioplasty, and no case had limb amputation or died. Conclusion: In combination with other appropriate endovascular procedures, balloon dilation angioplasty can offer satisfactory efficacy for in-stent restenosis in lower limb arteries.


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引用

引用本文: 元兵 吴, 云峰 朱, 红卫 葛, 永斌 朱, 诚 陈, 鑫 王. 下肢动脉硬化闭塞症腔内治疗后支架内再狭窄的治疗[J]. 中国普通外科杂志, 2015, 24(12): 1687-1690.
Cite this article as: WU Yuanbing, ZHU Yunfeng, GE Hongwei, ZHU Yongbin, CHEN Cheng, WANG Xin . Management of in-stent restenosis in lower limb arteriosclerosis obliterans after endovascular treatment[J]. Chin J Gen Surg, 2015, 24(12): 1687-1690.