目的:评价采用仰卧位腘动脉穿刺入路对闭塞段行双向开通的可行性及近期疗效。方法2013年3月至2015年12月,18例股腘动脉闭塞性病变患者,在顺行开通困难时采用仰卧体位下腘动脉逆行入路进行开通手术。病变长度(23.6±11.3)cm。Rutherford分级3~5级。腘动脉逆行穿刺时,患者取仰卧位膝关节外旋,在经近侧血管鞘造影的指引下完成穿刺并置入血管鞘。一旦逆行通过闭塞段进入真腔以后,再顺行置入球囊预扩、释放支架。结果18例患者仰卧位腘动脉穿刺成功率为100%,无穿刺点出血、血肿、假性动脉瘤、动静脉瘘等并发症。 ABI由术前的0.42±0.15上升为术后的0.83±0.13(P<0.001)。临床症状明显改善。平均随访时间(15.2±9.8)个月,12例(66.7%)股腘动脉通畅,闭塞6例。6、12及24个月初始通畅率分别为100%、83.1%及60.6%,4例症状严重的再发闭塞患者接受二次治疗。结论在进行股腘动脉硬化闭塞症腔内治疗过程中,如果顺行开通困难,采用仰卧位腘动脉入路是一种安全,有效的措施。
Objective To evaluate the feasibility and short term effectiveness of popliteal artery retrograde access in the supine position for treatment of chronic total occlusive (CTO) disease of superficial femoral artery (SFA) and proximal popliteal artery (PA). Methods Form March 2013 to December 2015, 18 patients with CTO of SFA and proximal PA were recanalized through popliteal retrograde access in the supine position after failure of antegrade procedure. Artery occlusion length in average was 23.6±11.3 cm , and the Rutherford classification was 3~5 level. During the procedure , the patient remained supine position with the knee in a external rotation. Under the guidance of angiogram via the proximal sheath , PA puncture was performed and the sheath was inserted. As soon as the retrograde wire crossed the occlusive segment and guided into the proximal sheath , the balloon pre-dilation and stent deployment were performed through antegrade approach. Results Technical success rate of PA puncture in the supine position achieved 100%. Bleeding, hematoma, pseudoaneurysm or arteriovenous fistula was not found at the popliteal puncture site. The ankle-brachial index (ABI) before and after procedure was significantly different (0.42±0.15 vs 0.83± 0.13, P<0.001). The clinical symptoms were improved obviously. During the follow-up period of 15.2±9.8 months, SFA and proximal PA was patent in 12 cases, and restenosed in 6 patients. Primary patency was 100%,83.1% and 60.6% at 6-month, 1- and 2-year after operation, respectively. Four patients underwent recanalization procedure owing to severe recurrence. Conclusion The retrograde PA access with the supine position can be considered as a safe and efficient method for recanalization of SFA and proximal PA after failure of antegrade approach.