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经皮机械血栓切除术治疗伴主-髂动脉闭塞的急性肢体缺血

Percutaneous Mechanical Thrombectomy for Acute Limb Ischemia With Aorto-iliac Occlusion.

作者信息

Yang Xinrui, Li Xiangxiang, Yin Minyi, Wang Ruihua, Ye Kaichuang, Lu Xinwu, Li Weimin, Cheng Yong, Qin Jinbao

机构信息

Department of Vascular Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, Shanghai, China.

Vascular Center of Shanghai JiaoTong University, Shanghai, China.

出版信息

Front Surg. 2022 Apr 26;9:831922. doi: 10.3389/fsurg.2022.831922. eCollection 2022.

Abstract

BACKGROUND

To evaluate the outcomes of percutaneous mechanical thrombectomy (PMT) with Rotarex catheter in patients with acute lower limb ischemia (ALI) caused by aorto-iliac occlusion.

MATERIALS AND METHODS

Data of patients with ALI caused by aorto-iliac occlusion in our institutions from January 2010 and April 2020 were reviewed. The primary end point was limb salvage rate. The secondary end points included technical success rate, survival rate, complications after the operation and during the follow-up.

RESULTS

A total of 85 patients with ALI was diagnosed with aorto-iliac occlusion. Thirty-eight patients were treated by PMT with Rotarex catheter and enrolled in present study. Twenty-four were male (63.2%), and 14 were female (36.8%). The mean age was 66 years (range 28-83). All 38 patients were treated with PMT, with additional catheter directed thrombolysis (2/38, 5.3%), balloon angioplasty (8/38, 21.1%) and stent deployment (7/38, 18.4%). The mean procedure time was 123 ± 31 min. Seven patients (18.4%) underwent continuous renal replacement therapy. Two patients received major amputations (above the knee) and 2 patients died for renal insufficiency and heart failure during the hospital stay. Thirty-day survival rate was 94.7% and limb salvage was 94.4%. The mean follow-up time was 14.0 months (8-22 months). There was no major amputation and target artery occlusion occurred during the follow-up period.

CONCLUSION

PMT with Rotarex catheter could be new option for acute aorto-iliac occlusion, leading to safe and effective results.

摘要

背景

评估使用Rotarex导管进行经皮机械血栓切除术(PMT)治疗由主-髂动脉闭塞引起的急性下肢缺血(ALI)患者的疗效。

材料与方法

回顾了2010年1月至2020年4月在我们机构中由主-髂动脉闭塞引起的ALI患者的数据。主要终点是肢体挽救率。次要终点包括技术成功率、生存率、术后及随访期间的并发症。

结果

共85例ALI患者被诊断为主-髂动脉闭塞。38例患者接受了使用Rotarex导管的PMT治疗并纳入本研究。24例为男性(63.2%),14例为女性(36.8%)。平均年龄为66岁(范围28 - 83岁)。所有38例患者均接受了PMT治疗,另外还进行了导管直接溶栓(2/38,5.3%)、球囊血管成形术(8/38,21.1%)和支架置入(7/38,18.4%)。平均手术时间为123±31分钟。7例患者(18.4%)接受了持续肾脏替代治疗。2例患者接受了大截肢(膝上),2例患者在住院期间因肾功能不全和心力衰竭死亡。30天生存率为94.7%,肢体挽救率为94.4%。平均随访时间为14.0个月(8 - 22个月)。随访期间未发生大截肢和靶动脉闭塞。

结论

使用Rotarex导管进行PMT可能是急性主-髂动脉闭塞的一种新选择,可带来安全有效的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bef6/9116458/67f472c11f62/fsurg-09-831922-g0001.jpg

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