Experience of Arteriosclerosis Obliterans of Lower Extremities by Endovascular Treatment_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SHI Tianxiong , MIAO Jianhang , HU Xixiang.

The Second Department of General Surgery, Zhongshan City People’s Hospital, Zhongshan 528403, Guangdong Province, China;

Corresponding author：

Keywords：

Lower extremity; Arteriosclerosis obliterans; Endovascular treatment; Percutaneous transluminal angioplasty; Stent

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Objective To explore the clinical experience of endovascular treatment for arteriosclerosis obliterans (ASO) of lower extremities.
Methods Endovascular treatment were performed on 22 patients (26 limbs) suffering from ASO which were diagnosed by magnetic resonance angiography (MRA). The clinical efficacy after operation was analyzed. Results Twentytwo lower extremities of 18 patients successfully accepted endovascular treatment with 12 stents planted without major complications. Four cases failed to endovascular treatment and 2 of them converted to bypass surgery. The clinical symptoms of limb ischemia vanished or significantly improved after treatment. The ankle brachial index (ABI) of affected extremities increased from 0.35±0.13 (before operation) to 0.70±0.15 (after operation), P lt;0.01. During the follow-up of 2-18 months, 3 cases suffered re-occlusion of artery of lower extremity, in them one case received drug treatment and 2 cases resolved by percutaneous transluminal angioplasty (PTA) and stenting again.
Conclusion Endovascular treatment for ASO of lower extremities has such advantages as minimal invasiveness, reduced complications and repeatability. It may serve as a more promising choice of method to clinical treatment of ASO.

Citation： SHI Tianxiong,MIAO Jianhang,HU Xixiang.. Experience of Arteriosclerosis Obliterans of Lower Extremities by Endovascular Treatment. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(7): 676-678. doi: Copy

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11.	张希全, 凌宝存, 朱伟, 等. 下肢动脉硬化闭塞疾病血管腔内治疗 [J]. 当代医学, 2009; 15(17): 284286.
12.	曹振远, 刘增尧, 冷久成, 等. 下肢动脉闭塞性病变的介入治疗 [J]. 中国介入放射学, 2009; 3(1): 2123.
13.	潘升权, 万圣云, 丁洋. 下肢动脉硬化闭塞症临床检查方法的现状 [J]. 安徽医药, 2009; 13 (2): 211213.
14.	Fontaine R, Buck P, Riveaux R, et al. Treatment of arterial obliterations; respective value of thrombectomies and thromboendarteriectomies, of arteriovenous shunts, and of vascular grafts (fresh venous autografts) [J]. Lyon Chir, 1951; 46(1): 7394.
15.	苑超. 下肢缺血的腔内治疗现状 [J]. 中国医学科学院学报, 2007; 29(1): 2124.
16.	肖亮, 徐克, 张曦彤, 等. 42例介入治疗髂动脉和股动脉闭塞性病变的临床疗效观察 [J]. 中华放射学杂志, 2008; 42(8): 840843.
17.	Norgren L, Hiatt WR, Dormandy JA, et al. Intersociety consensus for the management of peripheral arterial disease (TASC Ⅱ) [J]. Eur J Vasc Endovasc Surg, 2007; 33 Suppl 1: S1S75.
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19.	Schillinger M, Sabeti S, Loewe C, et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery [J]. N Engl J Med, 2006; 354(18): 18791888.
20.	吴丹明, 周玉斌. 多节段下肢动脉闭塞的治疗 [J]. 中国实用外科杂志, 2008; 28(10): 848851.
21.	崔卫东, 郭魁元, 崔晓兵, 等. 下肢动脉硬化闭塞症的杂交手术治疗研究 [J]. 医药论坛杂志, 2009; 30(9): 2526.
22.	Slovut DP, Demaioribus CA. Hybrid revascularization using Silverhawk atherectomy and infrapopliteal bypass for limb salvage [J]. Ann Vasc Surg, 2007; 21(6): 796800.
23.	Leon LR Jr, Mills JL, Psalms SB. A novel Hybrid approach to the treatment of common iliac aneurysms: antegrade endovascular hypogastric stentgrafting and femorofemoral bypass grafting [J]. J Vasc Surg, 2007; 45(6): 12441248.
24.	李伟, 张小明, 张学民, 等. 弹簧支架在下肢动脉硬化性狭窄和闭塞治疗中的应用 [J]. 中华普通外科学杂志, 2006; 21(12): 856858.
25.	Saxon RR, Coffman JM, Gooding JM, et al. Longterm patency and clinical outcome of the Viabahn stentgraft for femoropopliteal artery obstructions [J]. J Vasc Interv Radiol, 2007; 18(11): 13411349.
26.	马震寰, 杨镛, 杨国凯, 等. 下肢动脉硬化闭塞症继发血栓形成治疗分析 [J]. 中国普外基础与临床杂志, 2010; 17(3): 275277.
27.	胡骥琼,　王道明, 司春强, 等. 下肢动脉粥样硬化闭塞症截肢残体的血管解剖及临床意义 [J]. 中国普外基础与临床杂志, 2008; 15(6): 412415.

1. 刘昌伟. 下肢动脉硬化性闭塞症治疗指南 [J]. 中国实用外科杂志, 2008; 28(11): 923924.
2. 魏成志, 栗力. 下肢动脉硬化闭塞症的外科治疗进展 [J]. 中国老年学杂志, 2009; 29(24): 33173319.
3. 王玉琦, 史振宇. 我国血管外科的现状与展望 [J]. 中国普外基础与临床杂志, 2008; 15(6): 387389.
4. 缪健航, 师天雄, 胡锡祥, 等. 自体外周血干细胞移植治疗下肢动脉缺血性疾病的临床应用 [J]. 中国普外基础与临床杂志, 2008; 15(2): 106108.
5. 张宪生, 郭宏杰, 王维亮. 个体化血管重建术治疗下肢多平面动脉硬化闭塞症 [J]. 中国修复重建外科杂志, 2007; 21(7): 671674.
6. 陈建立, 常燕, 张国志, 等. 下肢动脉硬化闭塞症的个体化治疗经验 [J]. 现代预防医学, 2009; 36(4): 789790.
7. Krankenberg H, Schlüter M, Steinkamp HJ, et al. Nitinol stent implantation versus percutaneous transluminal angioplasty in superficial femoral artery lesions up to 10 cm in length: the femoral artery stenting trial (FAST) [J]. Circulation, 2007; 116(3): 285292.
8. Klein WM, van der Graaf Y, Seegers J, et al. Dutch iliac stent trial: longterm results in patients randomized for primary or selective stent placement [J]. Radiology, 2006; 238(2): 734744.
9. Tsetis D, Uberoi R. Quality improvement guidelines for endovascular treatment of iliac artery occlusive disease [J]. Cardiovasc Intervent Radiol, 2008; 31(2): 238245.
10. Park KB, Do YS, Kim JH, et al. Stent placement for chronic iliac arterial occlusive disease: the results of 10 years experience in a single institution [J]. Korean J Radiol, 2005; 6(4): 256266.
11. 张希全, 凌宝存, 朱伟, 等. 下肢动脉硬化闭塞疾病血管腔内治疗 [J]. 当代医学, 2009; 15(17): 284286.
12. 曹振远, 刘增尧, 冷久成, 等. 下肢动脉闭塞性病变的介入治疗 [J]. 中国介入放射学, 2009; 3(1): 2123.
13. 潘升权, 万圣云, 丁洋. 下肢动脉硬化闭塞症临床检查方法的现状 [J]. 安徽医药, 2009; 13 (2): 211213.
14. Fontaine R, Buck P, Riveaux R, et al. Treatment of arterial obliterations; respective value of thrombectomies and thromboendarteriectomies, of arteriovenous shunts, and of vascular grafts (fresh venous autografts) [J]. Lyon Chir, 1951; 46(1): 7394.
15. 苑超. 下肢缺血的腔内治疗现状 [J]. 中国医学科学院学报, 2007; 29(1): 2124.
16. 肖亮, 徐克, 张曦彤, 等. 42例介入治疗髂动脉和股动脉闭塞性病变的临床疗效观察 [J]. 中华放射学杂志, 2008; 42(8): 840843.
17. Norgren L, Hiatt WR, Dormandy JA, et al. Intersociety consensus for the management of peripheral arterial disease (TASC Ⅱ) [J]. Eur J Vasc Endovasc Surg, 2007; 33 Suppl 1: S1S75.
18. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. Trans Atlantic InterSociety Consensus (TASC) [J]. J Vasc Surg, 2000; 31 (1 Pt 2): S1S296.
19. Schillinger M, Sabeti S, Loewe C, et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery [J]. N Engl J Med, 2006; 354(18): 18791888.
20. 吴丹明, 周玉斌. 多节段下肢动脉闭塞的治疗 [J]. 中国实用外科杂志, 2008; 28(10): 848851.
21. 崔卫东, 郭魁元, 崔晓兵, 等. 下肢动脉硬化闭塞症的杂交手术治疗研究 [J]. 医药论坛杂志, 2009; 30(9): 2526.
22. Slovut DP, Demaioribus CA. Hybrid revascularization using Silverhawk atherectomy and infrapopliteal bypass for limb salvage [J]. Ann Vasc Surg, 2007; 21(6): 796800.
23. Leon LR Jr, Mills JL, Psalms SB. A novel Hybrid approach to the treatment of common iliac aneurysms: antegrade endovascular hypogastric stentgrafting and femorofemoral bypass grafting [J]. J Vasc Surg, 2007; 45(6): 12441248.
24. 李伟, 张小明, 张学民, 等. 弹簧支架在下肢动脉硬化性狭窄和闭塞治疗中的应用 [J]. 中华普通外科学杂志, 2006; 21(12): 856858.
25. Saxon RR, Coffman JM, Gooding JM, et al. Longterm patency and clinical outcome of the Viabahn stentgraft for femoropopliteal artery obstructions [J]. J Vasc Interv Radiol, 2007; 18(11): 13411349.
26. 马震寰, 杨镛, 杨国凯, 等. 下肢动脉硬化闭塞症继发血栓形成治疗分析 [J]. 中国普外基础与临床杂志, 2010; 17(3): 275277.
27. 胡骥琼,　王道明, 司春强, 等. 下肢动脉粥样硬化闭塞症截肢残体的血管解剖及临床意义 [J]. 中国普外基础与临床杂志, 2008; 15(6): 412415.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of Arteriosclerosis Obliterans of Lower Extremities by Endovascular Treatment

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