雜交手術治療多節段股腘動脈病變療效觀察_《中國修復重建外科雜志》

作者：

衛志慶 ¹ , 楊其鵬 ¹ , 龔秸明 ¹ , 劉長建 ²

1南京醫科大學第二附屬醫院血管外科（南京，210000）;;
2 南京大學醫學院附屬鼓樓醫院血管外科;

關鍵詞：

雜交手術多節段動脈硬化通暢率

DOI：

10.7507/1002-1892.20130295

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目的探討雜交手術治療累及股動脈至腘動脈的多節段動脈硬化病變的療效。方法2009年6 月－2012年6月，對22例累及股動脈至腘動脈的多節段動脈硬化病變患者采用雜交手術治療。其中男15例，女7例；年齡52～78歲，平均66.2歲。根據臨床癥狀分為FontaineⅢ級8例，Ⅳ級14例。病程6個月～5年，平均1.5年。術前踝肱指數（ankle brachial index，ABI）為0.32 ± 0.18，足背經皮氧分壓（transcutaneous oxygen pressure，TcpO2）為（17.6 ± 11.6） kPa，間歇性跛行距離為（160 ± 54）m。其中13例有吸煙史；合并2型糖尿病8例，高血壓16例，高血脂10例，冠心病11例，慢性腎衰竭1例。術后評價患者臨床癥狀改善情況，采用Kaplan-Meier生存分析及Log-rank 檢驗比較不同Fontaine分級患者間一期通暢率、輔助一期通暢率及二期通暢率。結果手術均順利完成，手術時間70～160 min，平均137 min。術后1例發生急性心肌梗死，1例局部切口血腫、感染，1例股淺動脈支架斷裂，1例股淺動脈支架內血栓形成。術后6個月患者ABI、足背TcpO2、間歇性跛行距離分別提高至0.79 ± 0.33、（42.7 ± 15.7） kPa、（420 ± 80）m，與術前比較差異均有統計學意義（P lt; 0.05）。術后患者均獲隨訪，隨訪時間6～24個月，平均14.5個月。一期通暢率為77.3%（17/22），輔助一期通暢率為90.9%（20/22），二期通暢率為95.5%（21/22），三者比較差異均無統計學意義（P gt; 0.05）。FontaineⅢ級和Ⅳ級患者間各期通暢率比較，差異均無統計學意義（P gt; 0.05）。結論雜交手術治療流出道良好的累及股動脈至腘動脈的多節段動脈硬化病變安全有效。

引用本文： 衛志慶,楊其鵬,龔秸明,劉長建. 雜交手術治療多節段股腘動脈病變療效觀察. 中國修復重建外科雜志, 2013, 27(11): 1359-1362. doi: 10.7507/1002-1892.20130295 復制

1.	Varu VN, Hogg ME, Kibbe MR. Critical limb ischemia. J Vasc Surg, 2010, 51(1): 230-241.
2.	Davies MG. Critical limb ischemia: introduction. Methodist Debakey Cardiovasc J, 2012, 8(4): 2.
3.	Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg, 2007, 45 Suppl S: S5-67.
4.	Han DK, Shah TR, Ellozy SH, et al. The success of endovascular therapy for all TransAtlantic Society Consensus graded femoropopliteal lesions. Ann Vasc Surg, 2011, 25(1): 15-24.
5.	Iida O, Nakamura M, Yamauchi Y, et al. Endovascular treatment for infrainguinal vessels in patients with critical limb ischemia: OLIVE registry, a prospective, multicenter study in Japan with 12-month follow-up. Circ Cardiovasc Interv, 2013, 6(1): 68-76.
6.	León LR Jr, Dieter RS, Gadd CL, et al. Preliminary results of the initial United States experience with the Supera woven nitinol stent in the popliteal artery. J Vasc Surg, 2013, 57(4): 1014-1022.
7.	胡驥瓊, 王道明, 司春強, 等. 下肢動脈硬化閉塞癥側支循環流出道的解剖學特點及臨床應用初探. 中國修復重建外科雜志, 2008, 22(5): 571-574.
8.	Kang JL, Patel VI, Conrad MF, et al. Common femoral artery occlusive disease: contemporary results following surgical endarterectomy. J Vasc Surg, 2008, 48(4): 872-877.
9.	周敏, 劉長建, 喬彤, 等. 雜交手術治療TASC D型下肢動脈硬化閉塞癥的臨床分析. 中華外科雜志, 2010, 48(22): 1735-1738.
10.	Matsagkas M, Kouvelos G, Arnaoutoglou E, et al. Hybrid procedures for patients with critical limb ischemia and severe common femoral artery atherosclerosis. Ann Vasc Surg, 2011, 25(8): 1163-1169.
11.	NishibeT, Kondo Y, Dardik A, et al. Hybrid surgical and endovacular therapy in mutifocal peripheral TASC D lesions: up to three-year follow-up. J Cardiovasc Surg (Torino), 2009, 50(4): 493-499.
12.	張憲生, 郭宏杰, 王維亮. 個體化血管重建術治療下肢多平面動脈硬化閉塞癥. 中國修復重建外科雜志, 2007, 21(7): 671-674.
13.	Lantis J, Jensen M, Benvenisty A, et al. Outcomes of combined superficial femoral endovascular revascularization and popliteal to distal bypass for patients with tissue loss. Ann Vasc Surg, 2008, 22(3): 366-371.
14.	Antoniou GA, Sfyroeras GS, Karathanos C, et al. Hybrid endovascular and open treatment of severe multilevel lower extremity arterial disease. Eur J Vasc Endovasc Surg, 2009, 38(5): 616-622.
15.	Naoum JJ, Arbid EJ. Bypass surgery in limb salvage: polytetrafluoroethylene prosthetic bypass. Methodist Debakey Cardiovasc J, 2012, 8(4): 43-46.
16.	Kinlay S. Outcomes for clinical studies assessing drug and revascularization therapies for claudication and critical limbischemia in peripheral artery disease. Circulation, 2013, 127(11): 1241-1250.
17.	Hirsch AT, Duval S. Effective vascular therapeutics for critical limb ischemia: a role for registry-based clinical investigation. Circ Cardiovasc Interv, 2013, 6(1): 8-11.
18.	Conte MS. Critical appraisal of surgical revascularization for critical limb ischemia. J Vasc Surg, 2013, 57(2 Suppl): 8S-13S.

1. Varu VN, Hogg ME, Kibbe MR. Critical limb ischemia. J Vasc Surg, 2010, 51(1): 230-241.
2. Davies MG. Critical limb ischemia: introduction. Methodist Debakey Cardiovasc J, 2012, 8(4): 2.
3. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg, 2007, 45 Suppl S: S5-67.
4. Han DK, Shah TR, Ellozy SH, et al. The success of endovascular therapy for all TransAtlantic Society Consensus graded femoropopliteal lesions. Ann Vasc Surg, 2011, 25(1): 15-24.
5. Iida O, Nakamura M, Yamauchi Y, et al. Endovascular treatment for infrainguinal vessels in patients with critical limb ischemia: OLIVE registry, a prospective, multicenter study in Japan with 12-month follow-up. Circ Cardiovasc Interv, 2013, 6(1): 68-76.
6. León LR Jr, Dieter RS, Gadd CL, et al. Preliminary results of the initial United States experience with the Supera woven nitinol stent in the popliteal artery. J Vasc Surg, 2013, 57(4): 1014-1022.
7. 胡驥瓊, 王道明, 司春強, 等. 下肢動脈硬化閉塞癥側支循環流出道的解剖學特點及臨床應用初探. 中國修復重建外科雜志, 2008, 22(5): 571-574.
8. Kang JL, Patel VI, Conrad MF, et al. Common femoral artery occlusive disease: contemporary results following surgical endarterectomy. J Vasc Surg, 2008, 48(4): 872-877.
9. 周敏, 劉長建, 喬彤, 等. 雜交手術治療TASC D型下肢動脈硬化閉塞癥的臨床分析. 中華外科雜志, 2010, 48(22): 1735-1738.
10. Matsagkas M, Kouvelos G, Arnaoutoglou E, et al. Hybrid procedures for patients with critical limb ischemia and severe common femoral artery atherosclerosis. Ann Vasc Surg, 2011, 25(8): 1163-1169.
11. NishibeT, Kondo Y, Dardik A, et al. Hybrid surgical and endovacular therapy in mutifocal peripheral TASC D lesions: up to three-year follow-up. J Cardiovasc Surg (Torino), 2009, 50(4): 493-499.
12. 張憲生, 郭宏杰, 王維亮. 個體化血管重建術治療下肢多平面動脈硬化閉塞癥. 中國修復重建外科雜志, 2007, 21(7): 671-674.
13. Lantis J, Jensen M, Benvenisty A, et al. Outcomes of combined superficial femoral endovascular revascularization and popliteal to distal bypass for patients with tissue loss. Ann Vasc Surg, 2008, 22(3): 366-371.
14. Antoniou GA, Sfyroeras GS, Karathanos C, et al. Hybrid endovascular and open treatment of severe multilevel lower extremity arterial disease. Eur J Vasc Endovasc Surg, 2009, 38(5): 616-622.
15. Naoum JJ, Arbid EJ. Bypass surgery in limb salvage: polytetrafluoroethylene prosthetic bypass. Methodist Debakey Cardiovasc J, 2012, 8(4): 43-46.
16. Kinlay S. Outcomes for clinical studies assessing drug and revascularization therapies for claudication and critical limbischemia in peripheral artery disease. Circulation, 2013, 127(11): 1241-1250.
17. Hirsch AT, Duval S. Effective vascular therapeutics for critical limb ischemia: a role for registry-based clinical investigation. Circ Cardiovasc Interv, 2013, 6(1): 8-11.
18. Conte MS. Critical appraisal of surgical revascularization for critical limb ischemia. J Vasc Surg, 2013, 57(2 Suppl): 8S-13S.

《中國修復重建外科雜志》

雜交手術治療多節段股腘動脈病變療效觀察

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《中國修復重建外科雜志》

雜交手術治療多節段股腘動脈病變療效觀察

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