Therapeutic Evaluation of Catheter-Directed Thrombolysis Combined with Multiple Minimally Invasive Techniques of Endovascular in The Treatment of Lower Extremity Atherosclerotic Occlusive Disease_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIGuo-jian ,  YANGYong , YANGGuo-kai , WANJia , MAZhen-huan , LUPing , DULing-juan

Department of Vascular Surgery, The Secondary People's Hospital of Yunnan Province, The Fourth Affiliated Hospital of Kunming Medical University, Kunming 650021, Yunnan Province, China;

Corresponding?author：

YANGYong, Email: yncvs126@126.com

Keywords：

Lower extremity atherosclerotic occlusive disease; Catheter-directed thrombolysis; Minimally invasive techniques of endovascular; Efficacy

DOI：

10.7507/1007-9424.20150279

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Objective To investigate the therapeutic evaluation of catheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular in the treatment of lower extremity atherosclerotic occlusive disease (ASO). Methods Clinical data of 64 ASO patients who were treated in our hospital from June 2011 to October 2014 were analyzed retrospectively. These patients were divided into two groups according to the therapies:33 patients were treated by catheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular (combination group), and the other 31 patients were only treated by multiple minimally invasive techniques of endovascular (intervention group). Comparison of the clinical indexes was performed between the 2 groups, including vascular patency rate, stent implantation rate, operation time, ankle-brachial index (ABI), saturation of blood oxygen (SO₂) of toes, temperature of foot skin, amputation rate, and hospitalization expense. Results In the same group (combination group and intervention group), compared with the time point of before operation, the clinical indexes of the ABI, SO₂ of toes, and temperature of foot skin were higher after operation (P<0.05). At the same time point of before or after operation, there were no significant difference between the 2 groups in ABI, SO₂ of toes, and temperature of foot skin (P>0.05). The vascular patency rate of combination group was higher than that of intervention group[97.0% (32/33) vs. 83.9% (26/31)], P<0.05. But the stent implantation rate[18.2% (6/33) vs. 64.5% (20/31)], amputation rate[3.0% (1/33) vs. 16.1% (5/31)], operative time[(2.0±0.5) h vs. (4.0±1.1) h], and hospitalization expense of patients who got successful limb salvage[(8 500±1 200) yuan vs. (34 000±2 100) yuan] of combination group were all lower or shorter than those of intervention group (P<0.05). After operation, there were no complication happened in the patients who got successful limb salvage of combination group (n=32) and intervention group (n=26). In postoperative 6 months, the lower extremity arteries in patients who got successful limb salvage of combination group and intervention group were all examined by color ultrasonography, and they were unblocked. The lower extremity arteries of the patients with stent implantation in the 2 groups suffered with no obvious stenosis or occlusion. Conclusions Catheter-directed thrombolysis combined with multiple minimally invasive techniques of endovascular can become one of the surgical treatment methods for ASO, which characterized by minimally invasive operation, effective treatment, and low cost.

Citation： LIGuo-jian, YANGYong, YANGGuo-kai, WANJia, MAZhen-huan, LUPing, DULing-juan. Therapeutic Evaluation of Catheter-Directed Thrombolysis Combined with Multiple Minimally Invasive Techniques of Endovascular in The Treatment of Lower Extremity Atherosclerotic Occlusive Disease. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(9): 1068-1072. doi: 10.7507/1007-9424.20150279 Copy

1.	?楊鏞, 王深明, 徐克. 微創血管外科學. 北京:科學出版社, 2011:350-355.
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3.	Rutherford RB. Standards for evaluating results of interventional therapy for peripheral vascular disease. Circulation, 1991, 83 (2 Suppl):16-17.
4.	蔣米爾, 黃英. 下肢動脈閉塞癥性疾病診治策略的演變與時代意義. 中國普外基礎與臨床雜志, 2010, 17(7):641-644.
5.	蔣米爾, 黃英. 下肢動脈粥樣硬化閉塞癥治療的過去、現在和未來. 外科理論與實踐, 2009, 14(3):249-256.
6.	楊鏞, 王深明, 谷涌泉. 實用外周血管介入治療學. 北京:科學出版社, 2013:77-108.
7.	康濤, 李曉強, 唐軍建, 等. 內膜下血管成形術治療股腘動脈硬化閉塞癥. 中國血管外科雜志:電子版, 2012, 4(2):79-82.
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9.	李大林, 張鯤, 顏京強, 等. 股淺動脈閉塞122例治療體會. 中國普外基礎與臨床雜志, 2015, 22(2):230-234.
10.	李茂全, 張慶, 夏文龍, 等. 機械性血栓切除和開通治療慢性血管內血栓. 介入放射學雜志, 2002, 11(4):260-262.
11.	谷涌泉, 郭連瑞, 齊立行, 等. SilverHawk斑塊切除治療動脈粥樣硬化導致的下肢缺血14例報告. 中國微創外科雜志, 2011, 11(11):1022-1024.
12.	佟鑄氏, 谷涌泉, 郭連瑞, 等. 多點穿刺技術在復雜下肢動脈閉塞性病變腔內治療中的應用. 介入放射學雜志, 2014, 23(7):572-574.
13.	楊淼, 張童, 石波, 等. 遠端動脈逆行穿刺治療復雜下肢動脈閉塞性病變的初步體會. 中華放射學雜志, 2012, 46(8):735-737.
14.	宋希濤, 劉昌偉, 曾嶸, 等. 股腘動脈慢性完全閉塞性病變腔內治療效果及預后分析. 中華醫學雜志, 2014, 94(9):641-645.
15.	谷涌泉. 下肢動脈硬化閉塞癥腔內治療的新進展. 中國普通外科雜志, 2014, 23(6):719-723.
16.	辛海, 白超, 王洋, 等. 裸支架與藥物洗脫支架腔內置入術治療膝下動脈缺血性疾病療效的Meta分析. 中國普外基礎與臨床雜志, 2014, 21(4):467-472.
17.	蔣米爾, 劉曉兵. 血管外科實驗研究進展——腔內技術的發展方向. 中華實驗外科雜志, 2013, 30(5):881-883.
18.	王向真, 李丹. 藥物涂層支架的研究進展. 心血管病學進展, 2014, 35(6):707-711.
19.	徐佑龍. 藥物洗脫球囊在血管介入治療中的應用. 心血管病學進展, 2013, 34(3):408-412.
20.	王旗, 周敏, 喬彤, 等. 藥物涂層支架的研究進展. 中華生物醫學工程雜志, 2013, 19(4):333-337.
21.	劉勇. 血管再狹窄預防新技術:藥物涂層球囊研究進展. 中華臨床醫師雜志:電子版, 2012, 6(6):1514-1516.
22.	李京雨, 張強, 路軍良, 等. 介入性再通術治療下肢動脈平齊閉塞病變. 中國介入影像與治療學, 2010, 7(3):216-220.
23.	Aleksynas N, Kaupas RS. The influence of various factors on results of subintimal angioplasty of superficial femoral artery occlusions. Medicina (Kaunas), 2007, 43(1):43-50.
24.	成軍, 王學虎, 肖樂, 等. 鹽酸沙格雷酯治療慢性下肢動脈缺血的療效觀察. 中華普通外科雜志, 2012, 27(11):890-892.
25.	付鵬, 劉曉霞. 阿托伐他汀抑制血管平滑肌細胞Cyr61的表達. 中國醫科大學學報, 2013, 42(7):612-614.

1. ?楊鏞, 王深明, 徐克. 微創血管外科學. 北京:科學出版社, 2011:350-355.
2. S?der HK, Manninen HI, Jaakkola P, et al. Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia:angiographic and clinical results. J Vasc Interv Radiol, 2000, 11(8):1021-1031.
3. Rutherford RB. Standards for evaluating results of interventional therapy for peripheral vascular disease. Circulation, 1991, 83 (2 Suppl):16-17.
4. 蔣米爾, 黃英. 下肢動脈閉塞癥性疾病診治策略的演變與時代意義. 中國普外基礎與臨床雜志, 2010, 17(7):641-644.
5. 蔣米爾, 黃英. 下肢動脈粥樣硬化閉塞癥治療的過去、現在和未來. 外科理論與實踐, 2009, 14(3):249-256.
6. 楊鏞, 王深明, 谷涌泉. 實用外周血管介入治療學. 北京:科學出版社, 2013:77-108.
7. 康濤, 李曉強, 唐軍建, 等. 內膜下血管成形術治療股腘動脈硬化閉塞癥. 中國血管外科雜志:電子版, 2012, 4(2):79-82.
8. 鄭江華, 陳開, 陳志龍, 等. TASC-Ⅱ C/DC/D級髂動脈閉塞的腔內治療. 中國普外基礎與臨床雜志, 2015, 22(2):216-219.
9. 李大林, 張鯤, 顏京強, 等. 股淺動脈閉塞122例治療體會. 中國普外基礎與臨床雜志, 2015, 22(2):230-234.
10. 李茂全, 張慶, 夏文龍, 等. 機械性血栓切除和開通治療慢性血管內血栓. 介入放射學雜志, 2002, 11(4):260-262.
11. 谷涌泉, 郭連瑞, 齊立行, 等. SilverHawk斑塊切除治療動脈粥樣硬化導致的下肢缺血14例報告. 中國微創外科雜志, 2011, 11(11):1022-1024.
12. 佟鑄氏, 谷涌泉, 郭連瑞, 等. 多點穿刺技術在復雜下肢動脈閉塞性病變腔內治療中的應用. 介入放射學雜志, 2014, 23(7):572-574.
13. 楊淼, 張童, 石波, 等. 遠端動脈逆行穿刺治療復雜下肢動脈閉塞性病變的初步體會. 中華放射學雜志, 2012, 46(8):735-737.
14. 宋希濤, 劉昌偉, 曾嶸, 等. 股腘動脈慢性完全閉塞性病變腔內治療效果及預后分析. 中華醫學雜志, 2014, 94(9):641-645.
15. 谷涌泉. 下肢動脈硬化閉塞癥腔內治療的新進展. 中國普通外科雜志, 2014, 23(6):719-723.
16. 辛海, 白超, 王洋, 等. 裸支架與藥物洗脫支架腔內置入術治療膝下動脈缺血性疾病療效的Meta分析. 中國普外基礎與臨床雜志, 2014, 21(4):467-472.
17. 蔣米爾, 劉曉兵. 血管外科實驗研究進展——腔內技術的發展方向. 中華實驗外科雜志, 2013, 30(5):881-883.
18. 王向真, 李丹. 藥物涂層支架的研究進展. 心血管病學進展, 2014, 35(6):707-711.
19. 徐佑龍. 藥物洗脫球囊在血管介入治療中的應用. 心血管病學進展, 2013, 34(3):408-412.
20. 王旗, 周敏, 喬彤, 等. 藥物涂層支架的研究進展. 中華生物醫學工程雜志, 2013, 19(4):333-337.
21. 劉勇. 血管再狹窄預防新技術:藥物涂層球囊研究進展. 中華臨床醫師雜志:電子版, 2012, 6(6):1514-1516.
22. 李京雨, 張強, 路軍良, 等. 介入性再通術治療下肢動脈平齊閉塞病變. 中國介入影像與治療學, 2010, 7(3):216-220.
23. Aleksynas N, Kaupas RS. The influence of various factors on results of subintimal angioplasty of superficial femoral artery occlusions. Medicina (Kaunas), 2007, 43(1):43-50.
24. 成軍, 王學虎, 肖樂, 等. 鹽酸沙格雷酯治療慢性下肢動脈缺血的療效觀察. 中華普通外科雜志, 2012, 27(11):890-892.
25. 付鵬, 劉曉霞. 阿托伐他汀抑制血管平滑肌細胞Cyr61的表達. 中國醫科大學學報, 2013, 42(7):612-614.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Therapeutic Evaluation of Catheter-Directed Thrombolysis Combined with Multiple Minimally Invasive Techniques of Endovascular in The Treatment of Lower Extremity Atherosclerotic Occlusive Disease

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