摘要:
目的： 探讨在复杂下肢动脉闭塞病变中，血管腔内超声(intravascular ultrasound, IVUS)对于腔内血管重建技术的指导价值。方法： 回顾分析2013年2月—2014年12月在血管重建前及重建后分别使用血管造影(digital subtraction angiography，DSA)及IVUS指导下应用血管介入技术治疗下肢动脉复杂病变12例。结果： 所有患者均成功进行IVUS检查。IVUS对介入手术的决策均起到了关键作用。1例腘动脉陷迫综合征血栓病变采用单纯溶栓治疗； 2例支架内再狭窄病例诊断为血栓合并内膜增生，进行溶栓后球囊扩张；1例覆膜支架再闭塞病例明确闭塞支架内血栓后采用溶栓治疗，同时发现远端残余狭窄病变后二期植入覆膜支架；7例动脉硬化闭塞病例中，2例诊断为血栓合并狭窄，予以溶栓后球囊扩张治疗，5例为长段慢性完全闭塞(CTO)病变，球囊扩张后植入裸支架；1例髂动脉炎性病变使用覆膜支架。术后随访时间6~18个月，平均随访时间(9.7±3.7)个月，病变血管6个月一期通畅率100%。结论： 在复杂下肢动脉闭塞病变的诊断与治疗中，需要IVUS实现更精确的病变血管观察，优化球囊、支架的选择及定位，评估治疗的满意度，减少及预防相关并发症。
Abstract:
Objective： To explore the value of intravascular ultrasound (IVUS) for endovascular reconstruction techniques in treating complex lower extremity arterial occlusive diseases. Methods： From February 2013 to December 2014, 12 patients with lower extremity arterial complex lesions were treated by digital subtraction angiography (DSA) and with IVUS guided application of vascular interventional technique before and after vascular reconstruction. Results： All patients were successfully examined by IVUS, and IVUS played a key role in the decision-making of the interventional procedure. One case of popliteal artery entrapment syndrome thrombosis lesion was treated by simple thrombolysis; 2 cases of in-stent restenosis diagnosed as thrombosis and intimal hyperplasia, which were treated with balloon expansion after thrombolysis; 1 case with stent restenosis was treated with thrombolysis, and at the same time, distal residual stenosis was found and stent graft was implanted during the second stage; 7 cases of arteriosclerosis obliterans: 2 cases, diagnosed as thrombosis and stenosis, were performed thrombolysis and then balloon expansion, and 5 cases, long chronic total occlusion lesions, were treated with balloon expansion and then implanted stent; 1 case of iliac artery lesions was used covered stent. The postoperative follow-up time was 6-18 months, the average follow-up time was (9.7±3.7) months, and the primary patency rate of six months was 100%. Conclusions： In the diagnosis and treatment of complex peripheral arterial occlusive disease, IVUS can help achieve a more accurate observation of the pathological changes of blood vessels, optimize balloon and stent selection and positioning, evaluate treatment satisfaction, and reduce and prevent complications.
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