ZHI Kang-kang, LIU Yan-dong, YANG Fu-tang, HUANG Tong, BAI Jun, ZOU Si-li, WU Yong-fa, WU Jian-jin, JI Xiang-guo, QU Le-feng

Department of Vascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China



Endovascular treatment of lower limb atherosclerosis obliterans by drug-perfused balloon or retrograde femoral artery angioplasty

ZHI Kang-kang, LIU Yan-dong, YANG Fu-tang, HUANG Tong, BAI Jun, ZOU Si-li, WU Yong-fa, WU Jian-jin, JI Xiang-guo, QU Le-feng*

Department of Vascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China

Objective： To analyze the effectiveness and safety of the treatment strategies for vascular restenosis after stent implantation in atherosclerosis obliterans (ASO). Methods： The clinical data of 5 cases who had received drug-perfused balloon from January to July in 2016 and 15 cases who had received femoral artery retrograde endarterectomy from June 2012 to July 2016 after presenting reocclusion or restenosis atherosclerosis lesions were reviewed retrospectively. The effects of surgery and complications in follow-up period were analyzed. The effectiveness, availability and safety of the above two methods were assessed. Results： The 20 patients had acquired an adequate blood perfusion in their distal limbs and got warmer on their feet after underwent drug-perfused balloon and stent implantation or femoral artery retrograde endarterectomy. In addition, they could have good palpitation in dorsal artery of feet and have better feelings on account of relieving pain. In the follow-up, no restenosis case had been found among them. Conclusions： The application of the stent angioplasty after using drug-perfused balloon and femoral artery retrograde endarterectomy on vascular restenosis after stent implantation in atherosclerosis lesions proved to be effective and safe, greatly reducing the restenosis or reocclusion frequency.

atherosclerosis obliterans; stent implantation; restenosis; femoral artery retrograde endarterectomy; drug-perfused balloon

下肢动脉粥样硬化闭塞症(atherosderosis obliterans, ASO)是一种伴随全身其他部位动脉粥样硬化的疾病，具有发病率高、致残程度高的特点。国内研究[1]报道，ASO发病率约为10%，且逐年上升，并呈年轻化发病的趋势。目前，患病群体以老年人为主，其中70岁以上人群发病率达20%。疾病严重程度不同，患者不一定表现为肢体缺血，仅有0.6%～9.2%的患者出现临床症状。目前，该疾病的主要治疗方式是球囊扩张后支架植入术，该术式操作时间短、创伤小、疗效快，但支架植入术后支架内再狭窄的发生率较高。下肢ASO在进行腔内治疗后1年内有40%～60%的再狭窄率，患者远期预后受到严重影响[2-3]。虽然目前针对支架植入术后支架内再狭窄的病例治疗方案很多，如单纯球囊扩张、植入裸支架、植入覆膜支架、植入药物涂层支架等，但上述治疗方案远期效果并不确切。我院近年来采用药物灌注球囊支架及股动脉逆行内膜剥脱术治疗60例下肢ASO支架植入术后支架内再狭窄，疗效确切，现报告如下。

1　资料与方法

1.1一般资料选择2012年6月1日—2016年7月1日在我院诊治的ASO支架植入术后再狭窄患者20例，其中男性12例，女性8例；年龄58～80岁，平均68.7岁。20例患者中，合并冠心病2例，高血压19例，2型糖尿病3例；有吸烟史者17例。

支架植入术后血管再狭窄诊断标准：患肢足部发凉，原间歇性跛行症状好转后又出现间歇性跛行，夜间出现静息痛。20例患者下肢动脉CT血管成像(CTA)、数字减影动脉造影(DSA)发现支架内血栓形成，血管再度狭窄、闭塞，病变管腔内径较术后小于50%；……