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目的探讨内膜下成形术治疗长段股浅动脉闭塞的临床价值及中期随访结果。方法采用内膜下成形术(subintimal angioplasty,SIA)治疗32例临床表现为间歇性跛行和重症下肢缺血的长段股浅动脉闭塞患者,对初始通畅率、保肢率及其影响因素、并发症等进行分析。结果 32例SIA成功31例,技术成功率96.9%,31例成功再通者6、12、24、36个月的初始通畅率分别为96.8%、78.9%、58.8%和47.0%。跛行患者和重症下肢缺血患者的初始通畅率比较,差异无统计学意义(P>0.05)。膝下流出道血管数量和闭塞病变的长度对初始通畅率有影响(P<0.05,P<0.01)。32例中仅2例截肢,保肢率93.8%。出现并发症2例,其中1例动脉穿孔,经植入支架后未发生严重后果;另1例为假性动脉瘤形成,经超声引导下注射凝血酶后消失。结论 SIA是治疗长段股浅动脉闭塞的有效方法,中期随访效果满意。
Objective To investigate the clinical value and follow-up results of subintimal angioplasty for the treatment of superficial femoral artery occlusion. Methods Thirty-two patients with long-term superficial femoral artery occlusion with intermittent claudication and severe lower extremity ischemia were treated with subintimal angioplasty (SIA). The initial patency rate, limb salvage rate and its influencing factors were analyzed Disease analysis. Results The success rate of 32 patients with SIA was 31 and the success rate was 96.9%. The initial patency rates of the successful recanalization of 31, 6, 12, 24 and 36 months were 96.8%, 78.9%, 58.8% and 47.0% respectively. There was no significant difference in initial patency between patients with claudication and patients with severe lower limb ischemia (P> 0.05). The number of inferior knee outflow tract blood vessels and the length of occlusion lesions had an effect on the initial patency rate (P <0.05, P <0.01). Only 2 cases of amputation in 32 cases, limb salvage rate of 93.8%. Complications occurred in 2 cases, 1 case of arterial perforation, no serious consequences after implantation of the stent; the other 1 case of pseudoaneurysm formation, under the guidance of ultrasound after thrombin injection disappeared. Conclusion SIA is an effective method for the treatment of superficial femoral artery occlusion. The follow-up results are satisfactory in the medium term.