摘要目的 探讨下肢动脉硬化闭塞症腔内治疗中并发急性肢体缺血的防治体会.方法 回顾性分析2003年6月至2012年4月接受腔内治疗的下肢动脉硬化闭塞症患者685例,并发急性肢体缺血54例；其中男性43例,女性11例,年龄56 ～ 82岁,平均72.3岁.缺血原因包括动脉栓塞43例(6.3％),血栓形成8例(1.2％),动脉夹层3例(0.3％)；发生在球囊血管成形及支架植入过程中36例,导管溶栓中17例,SilverHawk斑块切除中1例.采用腔内治疗32例,手术治疗9例,腔内治疗联合手术治疗13例.结果 50例患者治疗成功,4例治疗失败行手术截肢,无死亡病例.术后45例获得随访,随访3～96个月,平均40.3个月.随访中动脉栓塞患者下肢缺血症状复发6例,再次予以腔内治疗4例,2例行截趾术；血栓患者1例旁路术后吻合口狭窄予以球囊血管成形,1例支架内再狭窄行球囊血管成形支架植入；夹层患者1例膝下动脉支架闭塞,予以药物保守治疗,症状减轻.4例截肢患者随访情况良好.结论 腔内治疗术中并发急性肢体缺血多数患者可采用腔内技术处理,腔内治疗效果不佳时应转开放手术.

abstractsObjective To discuss the cause and treatment of acute limb ischemia in endovascular therapy of the lower extremity arterial occlusive disease.Methods Clinical data of 54 cases of acute limb ischemia in the endovascular treatment of 685 cases of lower extremity arterial occlusive disease from June 2003 to April 2012 was analyzed retrospectively.There were 43 male and 11 female patients,with a mean age of 72.3 years (ranging from 56 to 82 years).The major causes which resulted in acute limb ischemia included:arterial embolization of 43 cases,arterial thrombosis of 8 cases,arterial dissection of 3 cases.The acute limb ischemia occurred in the process of balloon angioplasty/stent in 36 cases,catheter-directed thrombolysis in 17 cases,Silverhawk atherectomy in 1 cases.Thirty-two cases were treated by endovascular treatment,9 cases by surgical procedures (bypass or embolectomy),13 cases by the combination of endovascular therapy and surgical procedures.Results Treatment were successfully accomplished in 50 of 54 cases,and failed in 4 cases which had surgical amputation.There were no deaths in all the patients.Forty-five of 54 cases were followed up for the average of 40.3 months.Six cases had ischemic symptoms recurrence in 43 artery embolization patients,in whom 4 cases were cured by endovascular treatment,2 cases were cured by toe amputation.One case of bypass anastomotic stenosis and one case of stent restenosis were successfully cured by endovascular treatment in 8 arterial thrombosis patients.One cases of below-knee artery stent occlusion in 3 arterial dissection patients was cured by medical treatment.Four cases of amputation patients were followed up in good condition.Conclusions Most patients of acute limb ischemia complicated in endovascular therapy could be treated by endovascular therapy.Surgical procedures in time is still the best choice for the patients in whom the endovascular therapy was not satisfied.