ObjectiveTo summarize the effects of endovascular intervention and artificial graft bypass for the occlusive superficial femoral artery disease. MethodsThe clinical data of 122 patients (136 limbs) with superficial artery occlusive disease underwent endovascular intervention or artificial graft bypass from January 2008 to April 2011 in this hospital were collected retrospectively. Age, TASCⅡgrading, condition of outflow tract, complications before and after procedures, hospital stay, primary patency rate, rate of amputation, and death rate were recorded. Results①Seventy-four limbs of 64 patients were accepted percutaneous transluminal angioplasty and stent graft (PTA/S group), 62 limbs of 58 patients were accepted femoral popliteal artery artificial graft bypass (artificial graft bypass group). Compared with the artificial graft bypass group, the age was significantly older (P < 0.05), TASCⅡA or B lesions were more (P < 0.05), TASCⅡC or D lesions were less (P < 0.05), the limbs with one or three outflow tracts were more (P < 0.05) in the PTA/S group. The limbs with two outflow tracts, and the patients combined with diabetes or hypertension or diabetes and hypertension had no significant differences between these two groups (P > 0.05).②There was no perioperative mortality in two groups. Compared with the artificial graft bypass group, the average hospital stay was sifnificantly shorter (P < 0.05), the 3-year death rate after procedure was higher (P < 0.05), the rate of postoperative incision infection was lower (P < 0.05), the primary patency rate of 36-month after operation was lower (P < 0.05) in the PTA/S group. The rate of amputation, the primary patency rates of 6-, 12-, and 24-month after operation had no significant differences between these two groups (P > 0.05). ConclusionsManagement of occlusive superficial femoral artery disease with femoral popliteal artery artificial bypass grafting exhibits a higher long term patency as compared with percutaneous stent graft. However, the hospital stay is longer than that in PTA/S group, and postoperative infection also occurres individually in artificial graft bypass group. Percutaneous transluminal angioplasty and stent graft has little trauma, faster recovery, shorter hospital stay, which is an important significance for the patients with too old or weak to accept femoral popliteal artery artificial graft bypass. But its long term patency rate needs to be improved.
目的探討低分子肝素預防下肢靜脈曲張術后深靜脈血栓形成的臨床效果。 方法將2011年1月至2013年12月期間于筆者所在醫院行大隱靜脈高位結扎＋分段剝脫術＋腔內激光閉合術的513例下肢靜脈曲張患者隨機分為2組：低分子肝素組238例，下肢靜脈曲張術后采用低分子肝素預防性治療；對照組275例，術后不采用任何抗凝藥物。比較2組患者深靜脈血栓形成和并發癥發生情況。 結果低分子肝素組發生浸透敷料的出血14例（5.9%），切口出血或皮下血腫25例（10.5%），血小板減少1例（0.4%），肝功能異常2例（0.8%），無深靜脈血栓形成發生；對照組發生浸透敷料的出血19例（6.9%），切口出血或皮下血腫27例（9.8%），肝功能異常2例（0.7%），深靜脈血栓形成7例（2.5%），無血小板減少發生。2組患者浸透敷料的出血、切口出血或皮下血腫、血小板減少及肝功能異常發生率比較差異均無統計學意義（P＞0.05），但低分子肝素組深靜脈血栓形成的發生率低于對照組（P＜0.05）。術后獲訪487例，隨訪時間為4～12個月，平均10個月。其中低分子肝素組獲訪225例，對照組獲訪262例。獲訪患者隨訪期間發生下肢靜脈曲張復發9例（低分子肝素組4例，對照組5例），隱神經損傷11例（低分子肝素組5例，對照組6例），無遠期下肢深靜脈血栓形成病例。2組患者的下肢靜脈曲張復發率和隱神經損傷發生率比較差異均無統計學意義（P＞0.05）。 結論采用低分子肝素預防下肢靜脈曲張術后下肢深靜脈血栓形成具有良好的臨床效果和安全性，值得臨床推廣應用。
ObjectiveTo evaluate the effect of percutaneous mechanical thrombectomy (PMT) with AngioJet mechanical thrombus aspiration system for the acute deep venous thrombosis (DVT) of lower extremities. MethodsThe clinical data of 72 patients (72 limbs) with acute DVT who underwent PMT with AngioJet system from December 2015 to June 2018 in our hospital were analyzed retrospectively. ResultsOf the 72 cases, 30 cases underwent PMT alone, while 42 cases underwent PMT combined with catheter directed thrombolysis (CDT). Thrombus clearance rate of grade Ⅲ was obtained in 49 cases (68.05%), grade Ⅱ in 20 cases (27.78%), and grade Ⅰ in 3 cases (4.17%). Thirty-five cases were found with May-Thurner syndrome, and 34 cases were treated with stenting while 1 case complicated with iliac bleeding. The rates of PTS were 1.41% (1/71), 3.57% (2/56), 4.55% (2/44), and 20.00% (3/15) at 3-month, 6-month, 1-year, and 2-year after intervention, respectively. The deep vein patency rates were 86.36% (38/44) and 80.00% (12/15) at 1-year and 2-year after intervention, respectively. The iliac stent patency rates were 100% (23/23) and 87.50% (7/8) at 1-year and 2-year after intervention, respectively. ConclusionThe effect of PMT assisted with CDT for the acute DVT of lower extremities is satisfactory, but its long-term efficacy needs to be further observed.