AngioJet在下肢动脉血栓栓塞性疾病治疗中应用
| 作者: |
1韩松,
2周修适,
2刘斐,
2史振宇,
2唐骁,
2严栋,
2郭大乔,
2符伟国,
2王利新
1 苏州大学附属太仓医院/江苏省太仓市第一人民医院 普通外科，江苏 太仓 215499 2 复旦大学附属中山医院血管外科/复旦大学血管外科研究所，上海 200032 |
| 通讯: |
王利新
Email: wang.lixin@zs-hospital.sh.cn |
| DOI: | 10.3978/.2017.12.011 |
| 基金: | 国家自然科学基金资助项目（81570438）。 |
摘要
目的：探讨使用AngioJet治疗下肢动脉血栓栓塞性疾病的临床效果并总结初步经验。
方法：回顾性分析2016年8月―2017年7月复旦大学附属中山医院血管外科使用AngioJet血栓抽吸系统治疗10例下肢动脉血栓栓塞性疾病患者（急性下肢动脉栓塞3例，下肢动脉硬化性闭塞症基础上急性血栓形成5例，原发性血栓形成2例）的临床资料。
结果：该10例（平均年龄61.60岁）手术均通过单独使用AngioJet或AngioJet联合其他方法获得成功，技术成功率100%。其中2例AngioJet抽吸后狭窄消失，6例患者使用AngioJet抽吸后有残余狭窄结合球囊扩张，2例抽吸后有残余狭窄结合球囊扩张+支架成形。由于抽吸后有残余血栓存在，3例行AngioJet吸栓+球囊扩张者和1例AngioJet吸栓+球囊扩张+支架植入者辅以喷药溶栓，1例行AngioJet吸栓+球囊扩张者和1例AngioJet吸栓+球囊扩张+支架植入者辅以置管溶栓（CDT）。术后平均住院（3.9±2.33）d，患者术后踝/肱指数较术前明显提高（0.84 vs. 0.37，P<0.05）。术后1例出现血尿，1例出现轻度肾功能损害。疗效评估结果为痊愈6例，良好4例。目前7例患者完成了6个月随访，无肢体缺血加重情况。
结论：对于急性下肢动脉血栓栓塞性疾病，使用AngioJet导管抽吸血栓安全、有效、创伤小。较为适合于股腘段血栓栓塞性病变，吸栓后残余狭窄明显可结合球囊扩张或支架植入，抽吸血栓效果不佳的可辅以CDT。
关键词：
血栓栓塞；下肢；血栓切除术；血管内操作
方法：回顾性分析2016年8月―2017年7月复旦大学附属中山医院血管外科使用AngioJet血栓抽吸系统治疗10例下肢动脉血栓栓塞性疾病患者（急性下肢动脉栓塞3例，下肢动脉硬化性闭塞症基础上急性血栓形成5例，原发性血栓形成2例）的临床资料。
结果：该10例（平均年龄61.60岁）手术均通过单独使用AngioJet或AngioJet联合其他方法获得成功，技术成功率100%。其中2例AngioJet抽吸后狭窄消失，6例患者使用AngioJet抽吸后有残余狭窄结合球囊扩张，2例抽吸后有残余狭窄结合球囊扩张+支架成形。由于抽吸后有残余血栓存在，3例行AngioJet吸栓+球囊扩张者和1例AngioJet吸栓+球囊扩张+支架植入者辅以喷药溶栓，1例行AngioJet吸栓+球囊扩张者和1例AngioJet吸栓+球囊扩张+支架植入者辅以置管溶栓（CDT）。术后平均住院（3.9±2.33）d，患者术后踝/肱指数较术前明显提高（0.84 vs. 0.37，P<0.05）。术后1例出现血尿，1例出现轻度肾功能损害。疗效评估结果为痊愈6例，良好4例。目前7例患者完成了6个月随访，无肢体缺血加重情况。
结论：对于急性下肢动脉血栓栓塞性疾病，使用AngioJet导管抽吸血栓安全、有效、创伤小。较为适合于股腘段血栓栓塞性病变，吸栓后残余狭窄明显可结合球囊扩张或支架植入，抽吸血栓效果不佳的可辅以CDT。
Application of AngioJet in treatment of lower extremity arterial thromboembolic disease
CorrespondingAuthor:WANG Lixin Email: wang.lixin@zs-hospital.sh.cn
Abstract
Objective: To investigate the clinical efficacy of using AngioJet in treatment of lower extremity arterial thromboembolic disease and report the preliminary experience.
Methods: The clinical data of 10 patients with lower extremity arterial thromboembolic disease (3 cases of acute arterial embolism of the lower extremities, 5 cases of acute thrombosis secondary to arteriosclerosis obliterans of the lower limbs, and 2 cases of primary thrombosis) undergoing thrombus aspiration with AngioJet system from August 2016 to July 2017 in Zhongshan Hospital of Fudan University were retrospectively analyzed.
Results: The operations in all the 10 patients (mean age of 61.60 years) were successfully completed by using AngioJet alone or together with other modalities, and the technique successful rate was 100%. Of the patients, stenosis disappeared in 2 cases after AnigoJet aspiration alone, 6 cases underwent balloon angioplasty and 2 cases underwent balloon angioplasty plus stenting due to residual stenosis after AnigoJet aspiration. Due to presence of remnant thrombi, 3 cases undergoing AnigoJet aspiration plus balloon angioplasty and one case undergoing AnigoJet aspiration plus balloon angioplasty and stenting were assisted by pulse-spray thrombolysis, and one case undergoing AnigoJet aspiration plus balloon angioplasty and one case undergoing AnigoJet aspiration plus balloon angioplasty and stenting were assisted by catheter directed thrombolysis (CDT). The average length of postoperative hospital stay was (3.9±2.3) d. The postoperative ankle-brachial index was significantly increased compared with the preoperative value (0.84 vs. 0.37, P<0.05). Hematuria and mild renal impairment occurred in one case each after operation. The treatment effectiveness assessment showed that 6 patients had complete cure and 4 patients had good response. Six-month follow-up was completed in 7 patients, and no exacerbation of limb ischemia was noted.
Conclusion: Thrombus aspiration using AngioJet system is safe, effective and less invasive for acute lower extremity arterial thromboembolic disease, and is especially suitable for thromboembolic lesions in the femoropopliteal segment. The residual stenosis after aspiration can be corrected by balloon angioplasty or combined with stent implantation, and CDT can be applied for those with ineffective thrombus aspiration.
Keywords：
Thromboembolism; Lower Extremity; Thrombectomy; Endovascular Procedures
Methods: The clinical data of 10 patients with lower extremity arterial thromboembolic disease (3 cases of acute arterial embolism of the lower extremities, 5 cases of acute thrombosis secondary to arteriosclerosis obliterans of the lower limbs, and 2 cases of primary thrombosis) undergoing thrombus aspiration with AngioJet system from August 2016 to July 2017 in Zhongshan Hospital of Fudan University were retrospectively analyzed.
Results: The operations in all the 10 patients (mean age of 61.60 years) were successfully completed by using AngioJet alone or together with other modalities, and the technique successful rate was 100%. Of the patients, stenosis disappeared in 2 cases after AnigoJet aspiration alone, 6 cases underwent balloon angioplasty and 2 cases underwent balloon angioplasty plus stenting due to residual stenosis after AnigoJet aspiration. Due to presence of remnant thrombi, 3 cases undergoing AnigoJet aspiration plus balloon angioplasty and one case undergoing AnigoJet aspiration plus balloon angioplasty and stenting were assisted by pulse-spray thrombolysis, and one case undergoing AnigoJet aspiration plus balloon angioplasty and one case undergoing AnigoJet aspiration plus balloon angioplasty and stenting were assisted by catheter directed thrombolysis (CDT). The average length of postoperative hospital stay was (3.9±2.3) d. The postoperative ankle-brachial index was significantly increased compared with the preoperative value (0.84 vs. 0.37, P<0.05). Hematuria and mild renal impairment occurred in one case each after operation. The treatment effectiveness assessment showed that 6 patients had complete cure and 4 patients had good response. Six-month follow-up was completed in 7 patients, and no exacerbation of limb ischemia was noted.
Conclusion: Thrombus aspiration using AngioJet system is safe, effective and less invasive for acute lower extremity arterial thromboembolic disease, and is especially suitable for thromboembolic lesions in the femoropopliteal segment. The residual stenosis after aspiration can be corrected by balloon angioplasty or combined with stent implantation, and CDT can be applied for those with ineffective thrombus aspiration.