中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (07): 594-596.

• 论著 • 上一篇    下一篇

血管腔内治疗伴有血栓形成主髂动脉闭塞性病变18例分析

叶    猛，张    皓，黄晓钟，赵意平，施娅雪，张纪蔚   

  1. 上海交通大学医学院附属仁济医院血管外科，上海 200001
  • 出版日期:2010-07-01 发布日期:2010-06-17

  • Online:2010-07-01 Published:2010-06-17

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摘要：

目的    探讨合并有血栓形成的主髂动脉闭塞性病变血管腔内治疗的可行性，安全性。方法    2006年6月至2008年2月，上海交通大学医学院附属仁济医院对18例伴有血栓形成的主髂动脉闭塞病人进行了血管腔内治疗。3例行股动脉切开取栓，同期腔内治疗髂动脉病变；9例行一期髂动脉导管溶栓（CDT），二期髂动脉病变腔内治疗术；6例行一期髂动脉球囊扩张及支架置入治疗，然后对髂动脉残留血栓进行CDT。结果    18例接受治疗的病人，术后有1例死亡。操作成功率83.3%,病死率5.6%，保肢率100％。随访时间12～26个月，平均14.5 个月。术后1年一期通畅率69.2%（9/13）， 一期辅助通畅率84.6%（11/13）， 二期通畅率92.3%（12/13）。行一期球囊扩张、支架置入病人CDT时间及所需尿激酶量均较一期CDT，二期球囊扩张、支架置入者显著减少（P<0.05）。结论    对伴有血栓形成的主髂动脉病变，可根据患肢缺血的严重程度选择相应的治疗方案。大部分无急性下肢动脉缺血症状的病人可通过血管腔内治疗结合CDT来恢复髂动脉血流，其创伤较小，操作成功率高，一期辅助通畅率和二期通畅率满意。

关键词: 动脉粥样硬化性闭塞症, 血栓, 介入治疗

Abstract:

Endovascular management of aortoiliac occlusive disease with thrombosis: an analysis of 18 cases        YE Meng，ZHANG Hao，HUANG Xiao-zhong, et  al.  Department of Vascular Surgery, Renji Hospital, Shanghai Jiaotong University，Shanghai 200001 ，China
Corresponding  author：ZHANG Ji-wei，E-mail: zhangjiwei001@sina.com.cn
Abstract    Objective    To review the outcomes and safety of endovascular treatment of aortoiliac occlusive disease with thrombosis. Methods    Between June 2006 and February 2008, 18 patients underwent treatment for occlusion of the aortoiliac arteries complicating with thrombosis at Renji Hospital of Shanghai Jiaotong University. Three patients underwent surgical thrombectomy with ad-junctive angioplasty; 9 patients underwent angioplasty secondary to thrombolysis; 6 patients underwent primary iliac angioplasty with adjunctive thrombolysis. Results    The technical success rate was 83.3%. The postoperative mortality rate was 5.6%, and limb survival rate was 100%. With a mean follow-up period of 14.5 months (range from 12～26 months), 1-year primary patency, assisted patency rates and second patency were 69.2%, 84.6% and 92.3%. Compared with angioplasty secondary to thrombolysis, the period of thrombolysis and the volume of urokinase decreased significantly in the group underwent primary angioplasty with thrombolysis(P<0.05). Conclusion    All the treatment are acceptable management strategies for aortoiliac occlusive disease with thrombosis. The appropriate choice of treatment depends on the severity level of the ischemia.

Key words: atherosclerosis occlusion, thrombus, interventional therapy