介入联合手术治疗长段髂动脉闭塞病变

李天润李选* 董国祥栾景源翟国钧张龙庄金满冯琦琛韩金涛
( 北京大学第三医院介入血管外科，北京100191)
【摘要】目的探讨介入联合手术治疗长段髂动脉闭塞病变的近期治疗效果。方法回顾性分析2008 年8 月～ 2010年6 月介入联合手术治疗11 例( 13 条) 长段髂动脉闭塞的临床资料。双侧髂动脉合并腹主动脉下段闭塞2 例( 4 条) ，髂动脉合并股总动脉闭塞6 例，髂动脉合并多发股浅或腘动脉闭塞3 例。对11 例( 13 条) 长段髂动脉闭塞病变行Fogarty 球囊取栓联合球囊扩张成形支架植入，并进行门诊和电话随访。结果13 条髂股动脉均开通成功，下肢缺血症状出现或加重2 个月内的7 条患肢术中取出较多血栓。术后未出现伤口感染、血肿、肺炎、死亡，术后1 周踝肱比( ABI) 由术前的0． 07 ± 0． 13 提高至0． 56 ± 0． 19，差异有显著性( t = 8． 517，P = 0． 000) 。随访12 ～ 28 个月，平均18 个月， 13 条患肢均保存良好，髂动脉一期通畅。结论介入联合手术治疗长段髂动脉闭塞病变的近期效果良好，并发症发生率较低。介入联合手术治疗在患肢缺血症状突然出现或加重2 个月内的髂动脉长段闭塞病变，以及髂动脉闭塞合并股总动脉闭塞病变的患者具有较大优势。
【关键词】动脉硬化闭塞; 髂动脉; 介入放射学
中图分类号: R654． 3 文献标识: A 文章编号: 1009 － 6604( 2012) 10 － 0922 － 03
Intervention Combined with Surgical Treatments for Long-segment Iliac Artery Occlusion Li Tianrun，Li Xuan，Dong
Guoxiang，et al． Department of Interventional Vascular Surgery，Peking University Third Hospital，Beijing 100191，China
【Abstract】Objective To investigate the short-term efficacy of interventional combined surgical treatments for long-segment iliac artery occlusion． Methods A retrospective analysis was made on 11 patients ( 13 limbs) with long-segment iliac artery occlusion，who underwent interventional combined surgical treatments in our hospital from August 2008 to June 2010． Among the cases，2 patients ( 4 limbs) had bilateral iliac artery occlusion complicated with lower aortic occlusion，6 patients showed occlusion in of the iliac artery and common femoral artery，and the other 3 patients had iliac artery occlusion combined multiple occlusions in the superficial femoral artery or popliteal artery． Fogarty catheter thrombectomy combined with balloon angioplasty was performed on all the patients． Follow-up at outpatient department or by phone call was carried out afterwards． Results The iliac artery was recanalized successfully in all the patients． In seven cases，who showed ischemia symptoms in the lower limbs or had the symptoms aggravated for
two months，several thrombi were removed． No incisional infection，hematoma，pneumonia，or death occurred after the procedure． The ABI was increased significantly from 0． 07 ± 0． 13 to 0． 56 ± 0． 19 in one week postoperation ( t = 8． 517，P = 0． 000) ． The patients were followed up for 12 to 28 months with a mean of 18 month，during which all the affected limbs were preserved well with patent iliac artery． Conclusions Interventional therapy combined with surgical treatment is effective in short term for long-segment iliac artery occlusion，with a low rate of complications． The procedure especially suits the patients who suddenly appeared or had aggravated ischemia symptoms or those who had iliac artery combined with common femoral artery occlusions．
【Key Words】Arteriosclerosis obliterans; Iliac artery; Interventional radiology