Straub Rotarex System联合药物涂层球囊治疗下肢动脉硬化闭塞症合并血栓栓塞的效果

Efficacy of Straub Rotarex System combined with drug-coated balloon in treatment of lower extremity atherosclerosis obliterans with thromboembolism

摘要:

目的 探讨Straub Rotarex System联合药物涂层球囊(DCB)治疗下肢动脉硬化闭塞症合并血栓栓塞的临床疗效。方法 回顾性分析2015年6月至2018年6月期间在赤峰市医院血管外科行Rotarex血栓清除装置减容联合DCB扩张治疗的下肢动脉粥样硬化闭塞症同时合并动脉栓塞或下肢动脉血栓形成的16例老年患者(16条患肢)的临床资料。明确诊断后接受介入手术治疗,先使用Rotarex血栓清除装置行经皮血栓清除减容,减容后造影评估,残余狭窄使用DCB扩张。观察患者治疗前后症状改善情况,对比治疗前后踝肱指数(ABI)变化,观察并发症发生情况。术后6~12个月门诊复查彩超评价通畅率,评估临床疗效。采用SPSS 22.0软件进行数据处理。组间比较采用t检验。结果 手术技术成功率100%。术后11例静息痛患者疼痛症状较术前显著缓解,疼痛视觉模拟评分(VAS)显著下降[(2.0±0.3)和(8.6±1.1),P<0.01]。5例间歇性跛行患者中3例患者术后跛行症状消失,2例患者间歇性跛行距离较术前明显延长。术后患肢ABI较术前显著提高[(0.87±0.06)和(0.29±0.10),t=19.89,P＜0.01]。术中发生1例(占6.25%)并发症,为远端动脉栓塞,再次机械减容后解除栓塞。所有患者均获得6~12个月随访,通畅率100%。结论 对于下肢动脉硬化闭塞症合并血栓栓塞的患者,Rotarex血栓清除装置联合DCB是一种安全有效的治疗方法,可作为优选治疗方案。

Abstract:

Objective To evaluated the efficacy of Straub Rotarex System combined with drug-coated balloon (DCB) in the treatment of lower extremity arteriosclerosis obliterans complicated with thromboembolism. Methods The clinical data of 16 elderly patients with lower limb ischemia treated with volume reduction using Straub Rotarex System combined with DCB dilatation from June 2015 to June 2018 were retrospectively analyzed. After definite diagnosis, percutaneous thrombectomy was performed for volume reduction with Straub Rotarex System, angiography was then performed, and residual stenosis was dilated with a DCB. The symptom improvement was observed, and ankle-brachial index (ABI) before and after treatment was compared, and the complications were observed. Patency and clinical efficacy were evaluated with color Doppler ultrasound at the outpatient clinic on follow-up visits during postoperative 6-12 months. SPSS statistics 22.0 was employed for data processing and t test for comparison between groups. Results Success rate of the operation was 100%. In 11 patients with resting pain, the pain was significantly relieved with significantly decreased visal analogue scale score [(2.0±0.3) vs (8.6±1.1), P<0.01]. Out of 5 patients with intermittent claudication, claudication disappeared in 3, and distances between two episodes of claudication were significantly lengthened. Postoperative ABI of the affected limb was significantly increased [(0.87±0.06) vs (0.29±0.10), t=19.89, P＜0.01]. Distal arterial embolization occurred intraoperatively in 1 patient, which was relieved after mechanical volume reduction. All patients were followed up for 6 to 12 months with a patency rate of 100%. Conclusion Rotarex thrombus system combined with DCB is safe and effective for patients with arteriosclerosis obliterans of the lower limb with thromboembolism, serving as a preferred therapeutic option for such patients.