积极的血管内再通技术对慢性完全动脉闭塞（CTO）成功率的影响。

Impact of aggressive endovascular recanalization techniques on success rate in chronic total arterial occlusions (CTOs).

作者信息

Sharafuddin Melhem J, Hoballah Jamal J, Kresowik Timothy F, Nicholson Rachael M, Sharp William J

机构信息

Department of Surgery, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA 52242, USA.

出版信息

Vasc Endovascular Surg. 2010 Aug;44(6):460-7. doi: 10.1177/1538574410370375. Epub 2010 May 18.

DOI:10.1177/1538574410370375

PMID:20484077

Abstract

PURPOSE

To report experience with aggressive recanalization approaches in chronic total arterial occlusion (CTO).

METHODS

Chronic total arterial occlusion recanalization was attempted on 112 limbs in 99 consecutive patients between January 1999 and December 2006.

RESULTS

There were 63 iliac arteries, 45 femoropopliteal arteries, and 4 occluded stents. Mean occlusion length was 8.7 ± 4.7 cm. Conventional recanalization was attempted first and was successful in 71 limbs (70%). Probing with the guidewire's stiff end was attempted in 33 of the 41 procedures where conventional techniques failed and was successful in 18 (54%), improving the overall procedural success rate to 80%. For the remaining 15 limbs, home-made directional sharp needle recanalization was attempted in 11 and was successful in 9 (82%), further improving the overall recanalization success to 88%. Procedural complications were self-limited or managed nonoperatively.

CONCLUSIONS

Aggressive recanalization techniques in CTO following failure of traditional means are safe and can substantially improve procedural success rates.

摘要

目的

报告在慢性完全动脉闭塞（CTO）中采用积极再通方法的经验。

方法

1999年1月至2006年12月期间，对99例连续患者的112条肢体尝试进行慢性完全动脉闭塞再通术。

结果

有63条髂动脉、45条股腘动脉和4个闭塞支架。平均闭塞长度为8.7±4.7厘米。首先尝试传统再通术，71条肢体（70%）成功。在41例传统技术失败的手术中，有33例尝试用导丝硬端进行探查，18例（54%）成功，使总体手术成功率提高到80%。对于其余15条肢体，11例尝试使用自制定向锐针再通术，9例（82%）成功，进一步将总体再通成功率提高到88%。手术并发症为自限性或通过非手术方式处理。