Dolmatch B L, Gray R J, Horton K M, Rundback J H, Kline M E
Department of Radiology, Washington Hospital Center, Washington, DC, USA.
J Vasc Interv Radiol. 1995 Jan-Feb;6(1):105-13. doi: 10.1016/s1051-0443(95)71071-5.
Areas of anastomotic stenosis in lower-extremity bypass grafts (BPGs) were treated by means of directional atherectomy (DA) in hopes of achieving better patency rates than have been reported with percutaneous transluminal angioplasty (PTA).
During a 4-year period, 17 patients (11 men and six women) with 23 areas of anastomotic stenosis in 18 lower-extremity BPGs were selected for treatment with DA. Urokinase thrombolysis was initially performed in eight BPGs that were thrombosed at the time of presentation. Adjunctive preatherectomy PTA was performed in six lesions, and postatherectomy PTA was performed in three lesions.
The technical success rate for DA was 92% (23 of 25 sites). There was less than 50% restenosis at 74% of the areas of stenosis (14 of 19 sites), with a mean follow-up time for the sites of 13 months. The graft patency rate was 88% (14 of 16 grafts), with a mean follow-up time for the grafts of 14 months. Areas of stenosis treated with DA alone had the same patency rates as those treated with DA and PTA.
DA is an effective treatment method for anastomotic peripheral arterial BPG stenosis. The intermediate-term patency rates following DA are superior to those reported for PTA and similar to those reported for surgical revision.
采用定向旋切术（DA）治疗下肢旁路移植血管（BPG）的吻合口狭窄区域，以期获得比经皮腔内血管成形术（PTA）报道的更高的通畅率。
在4年期间，选择18例下肢BPG中23处吻合口狭窄区域的17例患者（11例男性和6例女性）接受DA治疗。最初对8例就诊时血栓形成的BPG进行了尿激酶溶栓治疗。6处病变进行了旋切术前辅助PTA，3处病变进行了旋切术后PTA。
DA的技术成功率为92%（25个部位中的23个）。74%的狭窄区域（19个部位中的14个）再狭窄率低于50%，这些部位的平均随访时间为13个月。移植血管通畅率为88%（16条移植血管中的14条），移植血管的平均随访时间为14个月。单纯用DA治疗的狭窄区域与用DA和PTA治疗的狭窄区域具有相同的通畅率。
DA是治疗吻合口周围动脉BPG狭窄的有效方法。DA后的中期通畅率优于PTA报道的通畅率，与手术翻修报道的通畅率相似。
