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.
PAN Shengquan
,
YIN Shiwu
,
LI Jing
,
XIANG Tingmiao
,
LONG Haideng
,
FAN Weijian
. Analysis of the efficacy of bidirectional subintimal angioplasty in the treatment of TASC Ⅱ C and D grade ASO patients[J]. Journal of Baotou Medical College, 2025
, 41(6)
: 64
-68
.
DOI: 10.16833/j.cnki.jbmc.2025.06.012
[1] 徐创, 陈忠. 下肢动脉硬化闭塞症钙化病变的腔内治疗现况和进展[J] . 中国医药, 2020, 15(1): 144-146.
[2] Song PG, Rudan DA, Wang ML, et al. National and subnational estimation of the prevalence of peripheral artery disease (PAD) in China: a systematic review and meta-analysis[J]. J Glob Health, 2019,9(1):010601.
[3] 郑月宏. 下肢动脉硬化闭塞症诊治进展概述[J]. 中华老年多器官疾病杂志, 2020, 19(1): 7-10.
[4] Spinosa DJ, Leung DA, Harthun NL, et al. Simultaneous antegrade and retrograde access for subintimal recanalization of peripheral arterial occlusion[J]. J Vasc Interv Radiol, 2003, 14(11): 1449-1454.
[5] 唐郁宽, 张艳, 黄晨, 等. 双向内膜下血管成形术治疗下肢动脉闭塞性疾病的临床应用[J]. 中华介入放射学电子杂志, 2016, 4(2): 77-81.
[6] Komshian S, Cheng TW, Farber A, et al. Retrograde popliteal access to treat femoropopliteal artery occlusive disease[J]. J Vasc Surg, 2018, 68(1): 161-167.
[7] Spinosa DJ, Harthun NL, Bissonette EA, et al. Subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) for subintimal recanalization to treat chronic critical limb ischemia[J]. J Vasc Interv Radiol, 2005, 16(1): 37-44.
[8] 中华医学会外科学分会血管外科学组. 下肢动脉硬化闭塞症诊治指南[J]. 中华普通外科学文献(电子版), 2016, 10(1): 1-18.
[9] Norgren L, Hiatt WR, Harris KA, et al. TASC II section F on revascularization in PAD[J]. J Endovasc Ther, 2007,14(5):743-744.
[10] 郝阳, 郭晓辰, 张军平. 氧化应激和自噬在动脉粥样硬化中的作用研究新进展[J]. 中国动脉硬化杂志, 2017, 25(4): 404-410.
[11] Maldonado N, Kelly-arnold A, Laudier D, et al. Imaging and analysis of microcalcifications and lipid/necrotic core calcification in fibrous cap atheroma[J]. Int J Cardiovasc Imaging, 2015, 31(5): 1079-1087.
[12] Met R, Van Lienden KP, Koelemay MJW, et al. Subintimal angioplasty for peripheral arterial occlusive disease: a systematic review[J]. Cardiovasc Intervent Radiol, 2008, 31(4):687-697.
[13] Ye M, Zhang H, Huang XZ, et al. Retrograde popliteal approach for challenging occlusions of the femoral-popliteal arteries[J]. J Vasc Surg, 2013,58(1):84-89.
[14] Thind A, Strauss B, Teitelbaum A, et al. A novel method for the measurement of proximal fibrous cap puncture force in chronic total occlusions: the effect of increasing age[J]. EuroIntervention, 2011, 6(8): 997-1002.
[15] Vance AZ, Leung DA, Clark TW. Tips for pedal access: technical evolution and review[J]. J Cardiovasc Surg, 2018, 59(5):685-691.
[16] 张松, 黄梅, 殷述刚, 等. 膝下动脉逆穿技术在下肢动脉硬化闭塞症中的应用[J]. 齐齐哈尔医学院学报, 2020, 41(4): 419-421.
[17] Uyanık SA, Öğüşlü U, Yılmaz B, et al. Retrograde pedal access via occluded arteries in endovascular treatment of critical limb ischemia[J]. J Vasc Interv Radiol, 2021, 32(2):164-172.
[18] Zhuang KD, Patel A, Tan BS, et al. Outcome and distal access patency in subintimal arterial flossing with antegrade-retrograde intervention for chronic total occlusions in lower extremity critical limb ischemia[J]. J Vasc Interv Radiol, 2020, 31(4): 601-606.
[19] 张忠新, 丁文彬, 陈燕娥, 等. 超声引导下逆行穿刺膝下动脉在双向内膜下血管成形术中的应用[J]. 中华介入放射学电子杂志, 2017, 5(2): 83-85.
[20] 张欢, 牛鹿原, 罗小云, 等. 超声引导与透视引导下膝下动脉逆行穿刺在下肢动脉闭塞双向成形术中应用对比研究[J]. 中国实用外科杂志, 2020, 40(12): 1405-1408.
[21] 王炜, 刘长建, 乔彤. 透视引导下远端动脉逆行开通技术在下肢动脉慢性闭塞性疾病中的应用[J]. 介入放射学杂志, 2015, 24(2): 110-113.
