目的:观察透视下正逆行穿刺双向内膜下成形技术治疗下肢动脉硬化闭塞症(ASO)TASC Ⅱ C、D级病变的疗效及安全性。方法:收集分析2018年6月至2021年6月在合肥市第二人民医院介入血管科接受双向内膜下成形技术治疗的22例TASC Ⅱ C级、D级(共24条患肢)ASO患者的临床资料,统计手术成功率、住院并发症发生率及术后踝肱指数(ABI)的好转率。结果:23条患肢手术成功,1条患肢反复尝试后小腿段动脉顺行、逆行均未能成功开通闭塞段,成功率95.8%;术后并发症发生率为30.4%,死亡率0.0%,术后患肢ABI(0.79±0.16)较术前(0.27±0.19)改善明显(P＜0.05);6个月靶血管通畅率为91.3%(21/23);6个月内无新发截肢。结论:双向穿刺内膜下成形技术是一种安全、方便的腔内治疗方法,对于长段、复杂的下肢动脉闭塞性病变顺行无法开通时的一种有效的补救方法。
Objective: To observe the efficacy and safety of bidirectional subintimal angioplasty under fluoroscopy in the treatment of TASC Ⅱ C and D lesions of lower extremity arteriosclerosis obliterans (ASO). Methods: The clinical data of 22 patients with TASC Ⅱ grade C and D (24 limbs in total) ASO who underwent bidirectional subintimal angioplasty in the Department of Interventional Vascular, Hefei Second People's Hospital from June 2018 to June 2021 were collected. The success rate of operation, the incidence of complications in hospital and the improvement rate of ankle brachial index (ABI) after operation were statistically analyzed. Results: A total of 23 limbs were successfully operated, and 1 limb failed to open the occluded segment after repeated attempts of antegrade and retrograde arteries of the lower leg, with a success rate of 95.8%. The incidence of postoperative complications was 30.4%, and the mortality rate was 0.0%. The postoperative ABI was (0.79±0.16), which was better than(0.27±0.19) of the preoperative ABI (P＜0.05). The 6-month target vessel patency rate was 91.3% (21/23). There was no new amputation within 6 months. Conclusion: Bidirectional subintimal angioplasty is a safe and convenient endovascular treatment method. It is an effective remedy for long-segment and severe lower extremity arterial occlusive lesions that cannot be recanalized.
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