The Radiographic Classification And Clinical Significance Of Lower Extremities Thromboangiitis Obliterans

Objective: Preliminary discussion on image types and clinical significance of lower limbs arteriosclerosis occlusionMethods: The images and clinical data of 84 cases of lower limbs arteriosclerosis occlusion between January 2006 and January 2014 recorded in the Vascular Surgery of People’s Hospital of Xinjiang Uyghur Autonomous Region were subject to retrospective analysis. Wherein, 54 cases underwent revascularization,13 cases underwent autogenous saphenous vein bypass surgery [4 cases adopted iliofemoral lig artery bypass, 4 cases chose laptop hamstring artery bypass and 5 cases were subject to lap-bottom artery bypass(arteria tibialis cranialis was involved in 3 cases and arteria tibialis caudalis was involved for the other 2cases)]. 14 cases underwent catheter-directed thrombolysis combined with angioplasty. 4 cases were subject to balloon dilation and stent implantation and 23 cases received the treatment of embolectomy by arteriotomy and hematopoietic(iliofemoral lig section in 2 cases, hamstring section in 8 cases and lap-bottom section in 13 cases).Results: the image records show that the cases could be generally categorized into the types of iliofemoral lig, hamstring and lap-bottom. 16 cases of operation failed, including 4 cases of autogenous saphenous vein bypass surgery, 1 case of balloon dilation and stent implantation, 4 cases of catheter-directed thrombolysis combined with angioplasty and 7 cases of embolectomy by arteriotomy and hematopoietic stem cell transplantation. In the peri-operative period, 2 cases underwent amputation under knee, 3 cases underwent amputation above knee; 11 cases underwent toe amputation. All the patients had effective follow-up between 3 and 40 months((16+12) months on average). General rate of success was 70.4%. The patency rate six months after the surgery was 50%(24/48), and the patency rate 12 months after the surgery was64.6%(31/48).Conclusions: On the basis of clinical imaging data analysis, patients with lower limbs arteriosclerosis occlusion were roughly divided into three types, namely the iliofemoral lig type, the hamstring type and the lap-bottom type. Wherein, the first type is very rare and most cases have decent distal outflow. The latter two types are frequently seen and most cases usually do not have proper distal outflow under the closed plane surface. Therefore, different surgeries shall be chosen according to the vascular status of patients. For patients with proper distal outflow, autogenous saphenous vein bypass surgery is the first choice. For patients without proper distal outflow, catheter-directed thrombolysis would do a good job with satisfactory treatment effect. For chronicle patients who form acute thrombosis, the combined treatment of arteriotomy and stem cell transplantation could be a feasible and effective method.