[1]秦少华 王小微① 赵堂海* 郝庭嘉 战激光.腔内治疗TASC Ⅱ D型髂动脉硬化闭塞症并发症12例分析[J].中国微创外科杂志,2021,01(6):519-523.
　Qin Shaohua*,Wang Xiaowei,Zhao Tanghai*,et al.Analysis of 12 Cases of Complications of Endovascular Treatment for TASC Ⅱ D Iliac Arteriosclerosis Obliterans[J].Chinese Journal of Minimally Invasive Surgery,2021,01(6):519-523.
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腔内治疗TASC Ⅱ D型髂动脉硬化闭塞症并发症12例分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年6期
页码:
519-523
栏目:
短篇论著
出版日期:
2021-06-25

文章信息/Info

Title:
Analysis of 12 Cases of Complications of Endovascular Treatment for TASC Ⅱ D Iliac Arteriosclerosis Obliterans
作者:
秦少华 王小微① 赵堂海* 郝庭嘉 战激光
（中国人民解放军第九七〇医院血管外科，烟台264002）
Author(s):
Qin Shaohua*;  Wang Xiaowei;  Zhao Tanghai*;  et al.
*Department of Vascular Surgery, No. 970 Hospital of PLA, Yantai 264002, China
关键词:
髂动脉; 动脉闭塞性疾病; 血管腔内治疗; 并发症
Keywords:
Iliac artery; Arterial occlusive diseases; Endovascular therapy; Complication
文献标志码:
A
摘要:
目的探讨腔内技术治疗泛大西洋协作组织（TransAtlantic InterSociety Consensus，TASC）诊治指南Ⅱ D型髂动脉硬化闭塞症并发症的原因及防治策略。方法2014年6月~2019年12月，我院采用腔内技术治疗TASCⅡ D型髂动脉硬化闭塞症57例，发生围手术期并发症12例，对其资料进行回顾性分析。结果腔内操作相关并发症5例，包括术中髂动脉破裂1例，植入覆膜支架后动脉破口封堵不彻底，开放手术治愈；术后2 h迟发性髂动脉破裂1例，植入覆膜支架治愈；逆行开通闭塞的髂动脉过程中斑块脱落导致对侧髂总动脉栓塞1例，经球囊扩张+裸支架植入治愈；术后患肢蓝趾征2例，保守治疗治愈。穿刺点并发症2例，均行开放手术治愈。造影剂肾病（contrastinduced nephrology，CIN）5例，均经保守治疗肌酐恢复正常。12例均经门诊随访（22.7±11.6）月，2例术后14、20个月CTA检查示支架内再闭塞，10例病情稳定，无复发。结论并发症的原因主要是闭塞病变范围广、管壁钙化严重、基础疾病及术者技术水平。为减少并发症发生，应术前充分评估病变特点，选择合理的手术入路和方案，备齐各类器材及开放手术准备，对并发症早发现、早处理。
Abstract:
ObjectiveTo investigate the causes and prevention strategy of complications caused by endovascular technique in the treatment of TransAtlantic InterSociety Consensus (TASC) Ⅱ D iliac arteriosclerosis obliterans. MethodsFrom June 2014 to December 2019, 57 patients with TASC Ⅱ D iliac arteriosclerosis obliterans accepted endovascular treatment, and 12 of them occurred complications during the perioperative period. The clinical data of these cases were retrospectively analyzed.ResultsFive cases had complications related to endovascular operation, including 1 case suffered iliac artery rupture after stent implantation during operation (the covered stent was implanted immediately, but the rupture was not completely blocked, at last this patient was cured by open surgery), 1 case suffered delayed iliac artery rupture 2 hours after operation (was cured by implantation covered stent), 1 case of the contralateral common iliac artery embolization caused by plaque displacement during the retrograde opening of the occluded left iliac artery (was cured by balloon dilation + stent implantation), and 2 cases of bluetoe sign in the affected limb (both got better after the conservative treatment). Two cases had complications at the puncture point, and both of them were cured by open operation. Five cases had contrastinduced nephrology (CIN) after operation, all of them recovered to normal creatinine level after conservative treatment. All the 12 cases were followed up for an average of (22.7±11.6) months. Intrastent restenosis was found in 2 cases by computed tomographic angiography, which occurred 14 and 20 months after surgery, respectively. The remaining 10 cases were stable without recurrence.ConclusionsThe main reasons for the complications involve wider occlusion lesions, severe calcification of arterial wall, basic diseases and the skill of the operator. The following aspects are important to prevent complications: evaluating the characteristics of vascular lesions sufficiently before the operation; selecting reasonable surgical access and plan; arranging various equipments and preparing for the open surgery; persisting in the principle of "early detection, early treatment".

参考文献/References:

[1]Norgren L, Hiatt WR, Dormandy JA, et al. InterSociety Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg,2007,45（Suppl S）:S5-S67.
[2]谷涌泉,郭连瑞,齐立行,等.支架成形技术治疗近肾腹主动脉和双髂动脉闭塞的中长期疗效.中国微创外科杂志,2014,14(10)：957-959.
[3]Klein AJ,Nasir A.Iliac artery intervention.Interv Cardiol Clin,2020,9(2):187-196.
[4]中华医学会外科学分会血管外科学组.下肢动脉硬化闭塞症诊治指南.中华医学杂志,2015,95(24):1883-1896.
[5]秦少华,郝庭嘉,战激光,等.TASCⅡ D型髂动脉硬化闭塞症的腔内治疗.中华血管外科杂志,2020,5(4)：249-254.
[6]Thomsen HS.Guidelines for contrast media from the European Society of Urogenital Radiology.AJR Am J Roentgenol,2003,181(6):1463-1471.
[7]谷涌泉,郭建明,郭连瑞,等.覆膜支架腔内成形治疗平肾主髂动脉闭塞1例报告.中国微创外科杂志,2015,15(4)：350-351.
[8]Ahn S,Park KM,Kim YK,et al.Outcomes of endovascular treatment for TASC C and D aortoiliac lesions.Asian J Surg,2017,40(3):215-220.
[9]张欢牛,鹿原,张福先,等.定向斑块旋切系统联合药物涂层球囊治疗股腘动脉支架内再狭窄.中华普通外科杂志,2020,35(6):476-479.
[10]Haq MFU,Yip CS,Arora P.The conundrum of contrastinduced acute kidney injury.J Thorac Dis,2020,12(4):1721-1727.
[11]Morcos R,Kucharik M,Bansal P,et al.Contrastinduced acute kidney injury:review and practical update.Clin Med Insights Cardiol,2019,13:1179546819878680.
[12]Ribitsch W,Horina JH,Quehenberger F,et al.Contrast induced acute kidney injury and its impact on midterm kidney function,cardiovascular events and mortality.Sci Rep,2019,9(1):16896.
[13]Caraiani C,Petresc B,Dong Y,et al.Contraindications and adverse effects in abdominal imaging.Med Ultrason,2019,21(4):456-463.
[14]Briasoulis A,Pala M,Telila T,et al.Statins and contrastinduced nephropathy:a systematic review and metaanalysis.Curr Pharm,2017,13：7141-7148.
[15]Levin SR,Farber A Bertges DJ,et al.Larger sheath size for infrainguinal endovascular intervention is associated with minor but not major morbidity or mortality.Ann Vasc Surg,2019,60:327-334.e2.
[16]Inagaki E,Farber A,Siracuse JJ,et al.Routine use of ultrasound guidance in femoral arterial access for peripheral vascular intervention decreases groin hematoma rates in highvolume surgeons.Ann Vasc Surg,2018,51:1-7.
[17]Madden NJ,Calligaro KD,Zheng H,et al.Outcomes of brachial artery access for wndovascular interventions.Ann Vasc Surg,2019,56:81-86.

备注/Memo

备注/Memo:
*通讯作者，Email：zhaotanghai@sina.com ①（中国人民解放军第九六七医院血管外科，大连116000）
更新日期/Last Update: 2021-08-27