经 SilverHawk 动脉腔内斑块旋切术治疗的股腘动脉病变的临床及血液动力学演变。

Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, C/Ramón y Cajal no 3, 47005 Valladolid, Spain.

Eur J Radiol. 2011 Nov;80(2):543-7. doi: 10.1016/j.ejrad.2011.01.018. Epub 2011 Apr 2.

UNLABELLED

The objective of the work is to study the clinical and haemodynamic evolution, over 1 year, in patients with femoropopliteal arterial pathology treated by means of atherectomy with the SilverHawk device.

MATERIALS AND METHODS

Nineteen (19) patients were treated between December 2008 and May 2009, collecting data on sex, age, comorbidity and clinical degree, with prospective monitoring over 12 months of clinical symptoms, physical examination and ecodoppler, obtaining results on diameter and peak systolic velocity at different arterial levels.

RESULTS

Of the 19 patients, 14 were men and 5 women, with a mean age of 70 years, hypertensive (73%), diabetic (63%) and smokers (63%). Six (6) presented disabling claudication and 13 critical ischemia with advanced distal trophic lesions in 5. A good arteriographic result was obtained in 12 cases, a stent was placed on the superficial femoral artery in 5 due to suboptimal outcome. Contrast extravasation was observed in 2, with femoropopliteal bypass performed and one exclusion with endoprosthesis for repair. In the ecodoppler after 1, 3, 6 and 12 months, a progressive reduction in lumen diameter and peak intraarterial systolic velocity was observed, particularly on the distal superficial femoral artery. After one year, 7 patients (36.8%) were symptom-free, 5 (26.3%) presented mild or moderate intermittent claudication and 1 patient (5.3%) presented localised distal trophic lesion. Four (4) major amputations were performed, in 2 the knee was preserved, there were 3 thromboses due to the procedure, a secondary endovascular procedure was performed in one case and a femoropopliteal bypass in another, and there were 2 non procedure-related deaths.

DISCUSSION

atherectomy with SilverHawk achieves an improvement in clinical degree, with a good rate of extremity salvage in patients with critical ischemia. In the first year, the ecodoppler shows evolution of the arteriopathy, without this necessarily meaning a clinical worsening.

目的

研究 19 例采用 SilverHawk 动脉旋切术治疗股腘动脉病变患者的临床和血液动力学变化，随访 1 年。

材料与方法

2008 年 12 月至 2009 年 5 月共收治 19 例患者，记录性别、年龄、并存病及临床分级，前瞻性监测 12 个月的临床症状、体格检查和血管超声，获得不同动脉水平的直径和收缩期峰值流速结果。

结果

19 例患者中，男 14 例，女 5 例，平均年龄 70 岁，高血压（73%）、糖尿病（63%）和吸烟者（63%）。6 例有严重跛行，13 例有严重缺血伴 5 例远端营养性病变。12 例获得良好的血管造影结果，5 例因结果不理想在股浅动脉内置入支架。2 例出现造影剂外渗，行股腘旁路转流术，1 例采用人工血管修复行股浅动脉旷置术。1、3、6 和 12 个月后行血管超声检查，发现管腔直径和收缩期峰值流速逐渐减小，尤其在股浅动脉远端。1 年后，7 例（36.8%）无症状，5 例（26.3%）有轻度或中度间歇性跛行，1 例（5.3%）出现局部远端营养性病变。4 例（4）行大截肢术，2 例保留膝关节，3 例因手术出现血栓，1 例再次血管腔内治疗，1 例行股腘旁路转流术，2 例与手术无关的死亡。