摘要目的 探讨在介入治疗下肢动脉闭塞性病变导丝无法顺行通过闭塞段时改用逆行开通技术的临床意义.方法 回顾性分析27例下肢动脉闭塞性病变患者,男17例、女10例,年龄32～89岁,平均(70±12)岁.27例中下肢动脉硬化性闭塞症18例、糖尿病足7例、血栓闭塞性脉管炎2例.按Fontaine分期,Ⅱ期6例、Ⅲ期11例、Ⅳ期10例.在导丝无法顺行开通真腔、进入内膜下无法重返真腔或穿出血管外后,采用经足背动脉、胫后动脉穿刺或切开显露及利用足踝部胫后动脉、腓动脉、足背动脉的侧支血管进行逆行开通闭塞血管,再进行球囊扩张术和支架植入术.结果 27例手术均获得成功,血管开通后患者下肢缺血症状即刻得到改善.仅3例出现穿刺处血肿、1例足背动脉切开后足趾麻木,无严重围手术期并发症.术后5d平均踝肱指数由术前的0.37±0.11增加到0.85±0.12.结论 逆行开通技术可以作为常规正向开通技术治疗下肢动脉闭塞性病变失败时的一种补救方法,可以明显提高介入手术的成功率.

abstractsObjective To explore the clinical significance of retrograde access for the interventional treatment of lower extremity arterial occlusive diseases when the occluded segment of lower extremity artery could not be reached through antegrade access.Methods Twenty-seven cases (male 17,female 10; age range 32-89 years ) were retrospectively investigated, including 18 with lower limb arteriosclerosis obliterans,7 with diabetic foot and 2 with thromboangiitis obliterans.According to the Fontaine staging,6 cases were classified as Fontaine Ⅱ,11were classified as Fontaine Ⅲ and 10 were classified as Fontaine Ⅳ.All cases underwent endovascular operation through antegrade access first with an attempt to cross the occlusive segment,but in vain.So retrograde access was tried via puncture of pedis dorsalis or posterior tibial artery or exposure of lateral branches of posterior tibial artery,peroneal artery or dorsal artery by open surgery,which followed by Percutaneous transluminal angiography and (or) stenting.Results The operation through retrograde access was successful in all cases with obvious improvement of ischemic symptoms.Hematoma at the puncture site occurred in 3 patients,and paresthesia of toes occurred in 1after dorsalis pedis arteriotomy.No severe perioperative complication occurred.The average ankle brachial index increased from 0.37 ± 0.11preoperatively to 0.85 ± 0.12 postoperatively.Conclusions Retrograde access could be used as an alternative strategy in lower extremity arterial occlusive diseases when the occluded segment could not reach through antegrade access.