经皮控制钝性微分离血管重建术治疗骨盆和下肢症状性动脉闭塞的安全性和短期结果。
Safety and short-term outcomes following controlled blunt microdissection revascularization of symptomatic arterial occlusions of the pelvis and lower extremities.
机构信息
Section of Vascular Medicine, St Elizabeth's Medical Center, Boston, Massachusetts, USA.
出版信息
J Vasc Interv Radiol. 2009 Dec;20(12):1541-7. doi: 10.1016/j.jvir.2009.08.025.
PURPOSE
To present the safety and short-term outcomes of using controlled blunt microdissection catheter-assisted revascularization of symptomatic chronic total occlusions of the lower extremity.
MATERIALS AND METHODS
A retrospective study was performed on 61 patients (46 men) with a mean age of 72.3 years +/- 9.4 who underwent 67 procedures in 86 arteries between June 2003 and March 2007 for claudication (38 procedures, 57%), rest pain (19 procedures, 28%), and tissue loss (10 procedures, 15%). Technical success was defined as successful traversal of the occlusion. Duplex ultrasonography (US) was used to assess patency. Clinical patency was defined as at least one category improvement in Rutherford score from baseline and absence of target limb revascularization or major amputation at 6 months.
RESULTS
Chronic total occlusions were located in aortoiliac (11 arteries, 13%), infrainguinal (72 arteries, 83%), and infrapopliteal (four arteries, 5%) arteries. The mean lesion length was 14.2 cm +/- 8. The tibial run-off vessels was 1.9 vessels +/- 0.8. The technical success rate of the procedure was 84%. Advanced age (P = .04), renal function (P = .02), and target lesion length (P < or = .01) were predictors of technical failure. The clinical success rate at 6 months was 92%, and the primary patency with duplex US was 87%. Renal function (P < or = .01), length of the occlusion (P < or =.01), number of stents per procedure (P < or =.01), and tibial run-off vessels (P = .05) were the predictors of clinical success.
CONCLUSIONS
The controlled blunt microdissection catheter is safe in the revascularization of chronic total occlusions of the lower extremity. The technical success rate was 84% and predicted by age, renal function, and lesion characteristics. Clinical patency at 6 months was 92% and predicted by renal function, lesion characteristics, and run-off.
目的
介绍使用控制钝性微解剖导管辅助治疗下肢症状性慢性完全闭塞的安全性和短期结果。
材料与方法
回顾性分析 2003 年 6 月至 2007 年 3 月期间 61 例（46 例男性）患者的 67 例手术，共 86 条动脉，其中跛行（38 例，57%）、静息痛（19 例，28%）和组织损失（10 例，15%）。技术成功定义为成功穿过闭塞部位。采用超声（US）评估通畅性。临床通畅定义为 Rutherford 评分至少提高 1 级，且 6 个月内无靶肢体再血管化或大截肢。
结果
慢性完全闭塞位于腹主动脉髂动脉（11 条动脉，13%）、下肢（72 条动脉，83%）和腘动脉（4 条动脉，5%）。平均病变长度为 14.2cm±8cm。胫骨流出血管为 1.9 支±0.8 支。手术技术成功率为 84%。高龄（P=0.04）、肾功能（P=0.02）和目标病变长度（P≤0.01）是技术失败的预测因素。6 个月的临床成功率为 92%，超声检查的主要通畅率为 87%。肾功能（P≤0.01）、闭塞长度（P<0.01）、每例手术支架数量（P<0.01）和胫骨流出血管（P=0.05）是临床成功的预测因素。
结论
控制钝性微解剖导管在下肢慢性完全闭塞的再血管化治疗中是安全的。技术成功率为 84%，预测因素为年龄、肾功能和病变特征。6 个月时的临床通畅率为 92%，预测因素为肾功能、病变特征和流出。
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