Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taiwan.
Catheter Cardiovasc Interv. 2011 Feb 1;77(2):296-302. doi: 10.1002/ccd.22781.
To describe a procedural technique involving a combined antegrade femoral and retrograde tibial approach for treatment of complex popliteal and infrapopliteal occlusions, and to determine the safety and efficacy of this technique.
From May 2008 to March 2010, seven patients presenting with critical limb ischemia received dual vascular access intervention in this institution. Five legs were treated via the retrograde tibial approach after failure of antegrade intervention. A dual access approach was planned and adopted in another two legs. The target vessels were located at popliteal or infrapopliteal arteries.
We successfully gained all retrograde tibial access sites and achieved 100% procedural success and immediate hemodynamic improvement. Five legs required stent implantation to optimize the procedural results. No major complication occurred at the tibial access site. During the follow-up period (11.3 ± 7.2, range 3-23 months), no patients required any major amputation; only one patient underwent a mid-foot amputation. The target vessel revascularization rate at 3 and 6 months was 0 and 28.6%, respectively.
Dual vascular access was successfully used in a small number of selected patients and this technique may hold promise in improving the success rates in the treatment of complex popliteal and infrapopliteal occlusions.
描述一种联合顺行股动脉和逆行胫前动脉入路的治疗方法，用于治疗复杂的腘动脉和腘下动脉闭塞，并确定该技术的安全性和有效性。
2008 年 5 月至 2010 年 3 月，本机构收治了 7 例出现严重肢体缺血的患者，进行了双重血管入路介入治疗。5 条腿在顺行介入治疗失败后通过逆行胫前动脉入路进行治疗。另外两条腿计划并采用了双重入路。目标血管位于腘动脉或腘下动脉。
我们成功地获得了所有逆行胫前动脉入路部位，并实现了 100%的手术成功率和即时血流动力学改善。5 条腿需要支架植入术来优化手术结果。胫前动脉入路部位未发生重大并发症。在随访期间（11.3±7.2，范围 3-23 个月），没有患者需要进行任何主要截肢术，仅 1 例患者进行了中足部截肢术。3 个月和 6 个月时靶血管血运重建率分别为 0 和 28.6%。
双重血管入路在少数选定的患者中成功应用，该技术可能有望提高复杂的腘动脉和腘下动脉闭塞的治疗成功率。
