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目的观察采用多种介入治疗方法综合治疗下肢动脉闭塞性疾病的临床疗效。方法临床确诊的46例下肢动脉闭塞住院患者,均经血管造影证实。男39例,女7例;平均年龄65.3岁;病程2h～3年。急性发病15例,慢性发病31例。采用Seldingers穿刺技术股动脉入路,导管灌注尿激酶局部溶栓,视血管开通情况加经皮腔内血管球囊成形术(PTA)、内支架植入术。结果溶栓后血管开通33例,开通率71.7%;血管开通后未见明显狭窄者5例;血管存在严重狭窄者28例行PTA,其中16例PTA后不理想,内支架植入术后成功。随访1～48个月,彩色多普勒超声检查8例术后出现不同程度现狭窄,2例再次行PTA后不理想,支架植入术后成功。结论导管灌注尿激酶局部溶栓治疗为下肢动脉闭塞性疾病的首选方法 ,血管能否再通是进一步治疗的关键,PTA及内支架植入术作为溶栓后进一步治疗的手段,提高了临床疗效,改善了患者预后。
Objective To observe the clinical effects of multiple interventional therapy for the treatment of lower extremity arterial occlusive disease. Methods 46 cases of clinically diagnosed lower extremity arterial occlusion hospitalized patients were confirmed by angiography. 39 males and 7 females; average age of 65.3 years; duration of 2h ~ 3 years. 15 cases of acute onset, 31 cases of chronic disease. The Seldingers puncture technique was used to introduce the femoral artery. The catheter was perfused with urokinase to local thrombolysis. The vessels were opened with percutaneous transluminal angioplasty (PTA) and stent implantation. Results Thrombosis after thrombolysis in 33 cases, the opening rate of 71.7%; no significant stenosis after opening the vessel in 5 cases; severe vascular stenosis in 28 cases of PTA, of which 16 cases after PTA is not ideal, the success of stent implantation . All the patients were followed up for 1 ~ 48 months. The color Doppler echocardiography was performed in 8 patients with varying degrees of postoperative stenosis. Two patients were unsatisfactory after PTA again and the stent was successfully implanted. Conclusions Catheter infusion of urokinase local thrombolytic therapy is the preferred method of arterial occlusive disease of the lower extremities. Vascular recanalization is the key to further treatment. PTA and stenting as a further treatment after thrombolysis improve the clinical curative effect , Improve the patient’s prognosis.