小腿远端动脉逆行穿刺在下肢动脉闭塞性病变介入治疗中的应用

摘要

Objective To evaluate the effect of retrograde access for the interventional treatment of lower ex-tremity arterial occlusive disease (LEAOD). Methods From January 2016 to December 2016, seven patients, who had the popliteal and inferior genicular arterial occlusion, received endovascular treatment through antegrade access, but failed an attempt to cross the occlusive segment in the Department of Vascular Surgery of Hainan General Hospital. Ret-rograde access was immediately tried via puncture of posterior tibial artery (5 cases) or pedis dorsalis artery (2 cases). The guidewires crossed the occlusive segments and were guided into the true lumen. Percutaneous transluminal angiogra-phy was then performed. The success rate of retrograde arterial puncture, the retrograde revascularization of occlusive segment, the complication rate, the ankle brachial index (ABI) were observed. Results The operation through retro-grade access was successful in all 7 cases with the occlusive segment of the popliteal artery and anterior or posterior tibi-al artery retrograde recanalized. The ischemic symptoms of lower limb were obviously relieved. The ABI increased from (0.32 ± 0.13) preoperatively to (0.75 ± 0.14) postoperatively, and the difference reached statistical significance (P<0.05). No perioperative complications such as adjacent nerve and vascular injuries occurred. All patients were followed up for 3～19 months without severe intermittent claudication or resting pain recurrence. Conclusion For lower extremity arte-rial occlusive disease, especially the popliteal artery and inferior genicular artery, retrograde access could be used as an alternative strategy to improve the success rate of interventional therapy of LEAOD when the occluded segment could not cross through antegrade access.%目的 评价小腿远端动脉逆行穿刺在下肢动脉闭塞性病变介入治疗中的应用价值.方法 2016年1～12月海南省人民医院血管外科对7例腘动脉及膝下动脉闭塞患者采用导丝顺行开通失败,同期采用经小腿远端胫后、足背动脉逆行穿刺引导导丝逆行开通闭塞段动脉,然后对病变段进行球囊扩张.术中经胫后动脉穿刺5例,经足背动脉2例.观察远端动脉逆行穿刺的成功率、闭塞段病变的逆行开通率、并发症发生率及踝/肱指数(ABI).结果 本组7例患者小腿远端动脉逆行穿刺均获成功,其闭塞段腘动脉及胫前或胫后动脉均获逆行开通,术后下肢缺血症状得到缓解,未出现相邻神经、血管损伤等围术期并发症.术后ABI由术前的(0.32±0.13)升至(0.75±0.14),差异有统计学意义(P<0.05).随访期间,所有患者均未出现严重间歇性跛行或静息痛复发.结论 对于下肢动脉闭塞性病变,尤其是腘动脉及膝下动脉病变,如常规顺行开通失败,可采取小腿远端动脉穿刺逆行开通技术,以提高介入治疗的成功率.