小球囊预扩张联合导管溶栓治疗髂股动脉硬化闭塞症伴急性血栓形成

目的 观察以小球囊预扩张联合导管溶栓治疗髂股动脉硬化闭塞症伴急性血栓形成的价值。方法 纳入33例接受小球囊预扩张联合经导管溶栓治疗及血管成形术的单侧髂股动脉硬化闭塞症伴急性血栓形成患者，其中14例病变仅累及髂动脉、8例仅累及股动脉、11例同时累及髂股动脉；记录治疗情况及随访资料，包括临床症状、下肢动脉彩超及CT血管造影。结果 33例均治疗成功，经导管溶栓时间为3(2,4)天，25例血栓完全溶解、8例血栓部分溶解；溶栓后22例接受单纯球囊扩张、11例接受球囊扩张+支架植入术；治疗后复查数字减影血管造影示33例靶血管及膝下流出道血流均通畅。共随访(19.5±8.2)个月，期间7例出现下肢动脉再闭塞，经二次球囊扩张及植入支架后恢复通畅；无截肢及死亡病例。结论 小球囊预扩张联合经导管溶栓治疗髂股动脉硬化闭塞症伴急性血栓形成具有较高价值。

Small balloon pre-dilation combined with catheter-directed thrombolysis for treating iliofemoral arteriosclerosis obliterans complicated with acute thromboses

Objective To observe the value of small balloon pre-dilation combined with catheter-directed thrombolysis for treating iliofemoral arteriosclerosis obliterans complicated with acute thromboses. Methods Thirty-three patients with unilateral iliofemoral arteriosclerosis obliterans complicated with acute thromboses who underwent small balloon pre-dilation combined with catheter-directed thrombolysis and angioplasty were enrolled. Among 33 cases, only iliac artery was involved in 14 cases, only femoral artery was involved in 8 cases, while both iliac artery and femoral artery were involved in 11 cases. The treatment and follow-up data were recorded, including clinical symptoms, color Doppler ultrasound and CT angiography of lower limb artery. Results All 33 cases were successfully treated. The time of catheter-directed thrombolysis was 3 (2, 4) days. The thrombi were completely lysed in 25 cases while partially lysed in 8 cases. Among 33 cases, 22 cases underwent simple balloon dilation and 11 cases underwent balloon dilation+stent implantation after catheter thrombolysis. After treatment, re-examination of digital subtraction angiography showed that the target blood vessels and the outflow tract under the knee in 33 cases were unobstructed. Reocclusion of the lower limb arteries occurred in 7 cases during follow-up period of (19.5±8.2) months, but all were recanalized after secondary balloon dilation and stent implantation treatment. No amputation nor death occurred. Conclusion Small balloon pre-dilation combined with catheter-directed thrombolysis had high value for treating iliofemoral arteriosclerosis obliterans complicated with acute thromboses.