摘要目的 探讨拄拐导致腋动脉闭塞的介入治疗方法和效果.方法 6例长期拄拐患者突发腋动脉闭塞并伴有血栓形成,CTA和DSA检查明确诊断.采用泥鳅导丝行血栓闭塞段导丝穿通术,置入溶栓导管团注尿激酶25万U,然后保留导管尿激酶持续泵入1～3d.置管溶栓治疗后24、48、72 h行造影复查.造影显示血栓完全溶解并且显露动脉狭窄时,行狭窄段球囊扩张术,其中2例行支架置入术.结果 6例患者经置管溶栓治疗及血管腔内治疗后腋动脉均恢复通畅.1例球囊扩张患者3个月后腋动脉再次闭塞,予支架置入后血流恢复通畅,其余患者随访期间上肢动脉血流保持通畅.所有病例均未见明显并发症.结论 长期使用腋拐是腋动脉闭塞的原因之一,血管腔内治疗拄拐导致的腋动脉闭塞伴急性血栓形成具有疗效肯定、微创、安全的特点.

abstractsObjective To evaluate the endovascular therapy in the treatment of crutch-induced axillary artery occlusion and to discuss its technical points.Methods Acute axillary artery occlusion accompanied with thrombosis following long-time usage of unilateral axillary crutch were verified in 6 cases by computed tomography angiography (CTA) and digital subtraction angiography(DSA).Fist the guide-wire was inserted and pushed forward to pass through the thrombus,then bolus injection of urokinase (250 000 Units)through catheter was performed.Transcatheter micro-pump continuous infusion of urokinase was employed for 1-3 days until the thrombosis was completely dissolved,which was confirmed by angiography re-examination after 24,48 and 72 hours.Then the PTA and stents were implanted in those patients who revealed artery stenosis.Results The axillary arteries in 6 cases were proved to be reopen by post-treatment angiography.Occlusion of the axillary artery in a patient 3 month after the procedure was observed and was successfully treated with a stent.The other upper extremity arteries kept patency during follow-up.No major complications occurred and no patients died of complications related to the procedures.Conclusion Chronic axillary crutch use may be associated with axillary artery occlusion.For the treatment of acute crutch-induced axillary artery occlusion,endovascular treatment is a minimally invasive,effective,safe technique.