Harthun Nancy L, Cage Dorothy L, Spinosa David J
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Am Surg. 2004 Jun;70(6):479-82; discussion 482-3.
Subintimal recanalization is a percutaneous technique that allows revascularization in patients with limb-threatening ischemia. It was first described by Bolia (Cardiovasc Intervent Radiol 13;357-63:1990) but has not gained widespread use in the United States. Twenty-five patients with 32 threatened limbs were referred from a single surgeon's practice over a 23-month period. All patients were either high-risk surgical patients, due to severe medical comorbidities, or not surgical candidates due to poor target vessels, lack of appropriate conduit, or failed previous surgical revascularizations. The average age of patients was 69. There were 15 men and 10 women treated. Subintimal recanalization was immediately successful in 30 limbs. One peri-procedural death occurred, although this patient underwent a surgical bypass graft procedure in the same hospitalization. Three significant complications occurred (myocardial infarction, ventricular arrhythmia, and gastrointestinal hemorrhage). Primary patency is 83 per cent. Secondary patency is 90 per cent. Limb salvage rate is 88 per cent. Mean follow-up period is 10 months. Eight patients died in the follow-up period due to unrelated causes.
内膜下再通是一种经皮技术，可使有肢体威胁性缺血的患者实现血管再通。该技术最早由博利亚描述（《心血管介入放射学》13卷；357 - 63页：1990年），但在美国尚未得到广泛应用。在23个月的时间里，从一位外科医生的诊所转诊了25例患者，共32条受到威胁的肢体。所有患者要么因严重的内科合并症属于外科高风险患者，要么因靶血管不佳、缺乏合适的血管通道或既往外科血管再通失败而不适合手术。患者的平均年龄为69岁。接受治疗的有15名男性和10名女性。30条肢体的内膜下再通立即成功。发生了1例围手术期死亡，不过该患者在同一住院期间接受了外科搭桥手术。出现了3例严重并发症（心肌梗死、室性心律失常和胃肠道出血）。一期通畅率为83%。二期通畅率为90%。肢体挽救率为88%。平均随访期为10个月。8例患者在随访期内因无关原因死亡。
