Technique And Short-term Outcome Of Endovascular Treatmentof TASCⅡC And D LEAOD Lesions In The Elderly

Objective:Endovascular treatment was observed in elderly TASC Ⅱ C, D-term effect oflower extremity arterial occlusive disease (lower extremity atherosclerotic occlusivedisease, LEAOD) total occlusion and summarizes operative skills.Methods:The study collected Jilin University from November2010to February2014during the Third Clinical College Bethune percutaneous angioplasty in the treatmentof elderly former TASC Ⅱ C, D type of lower extremity arterial occlusive totalocclusions treated21cases (27limb), of which19males and2females; aged65-81years, mean69.6±6.3years old. In this study, the aforementioned cases,surgical success rate and short-term efficacy were analyzed retrospectively. Patientshad varying degrees of symptoms of intermittent claudication and ischemic rest pain.According to Fontaine patients with clinical grading system: Fontaine grade Ⅱgrade5cases, grade Ⅲ16cases. Preoperative ultrasound and measurement of lowerextremity arteries after the dorsalis pedis and posterior tibial arteries ankle-brachialindex, and a clear line of lower extremity arterial vascular lesions CTA. Accordingto the Trans-Atlantic Collaboration-Ⅱ (TransAlantic Inter-Society Ⅱ, TASC Ⅱ) on27limbs were classified LEAOD: C Type18(14cases), D-type9(7cases).10-40cigarettes/day>10years in15patients,9patients with diabetes mellitus,history of smoking.27dorsal artery surgery before limb ankle-brachial index(ankle-brachial index, ABI) from the0.39±0.14preoperatively; after preoperativetibial artery ABI0.45±0.12. Preoperative CTA shows LEAOD occluded segmentaverage length of (18.5±4.5) cm. All LEAOD lesions were treated by percutaneoustransluminal angioplasty (percutaneous transluminal angioplasty, PTA) or stentingcombined PTA (percutaneous transluminal angioplasty and stenting, PTAS)performed endovascular treatment. All patients in this study were combined with preoperative CTA Select surgical approach and design solutions. For the ipsilateraliliac artery lesions using the ipsilateral femoral artery by retrograde puncture; Forexternal iliac artery lesions in or near the femoral artery, femoral-popliteal arterylesions in the upper section, select the retrograde contralateral femoral arterypuncture using the " crosses " sheath; For shares-popliteal artery and poplitealartery under the following sections of ipsilateral femoral artery lesions usingantegrade puncture; for iliac artery occlusive disease, select the brachial arterypuncture. When the guide wire for iliac artery lesions can not be passed, such asremote outflow tract is acceptable, can be dual approach technology. Intraoperativeuse of alternating stepping technology, intimal recanalization techniques,technology and other climbing guide wire into the opening operation target arteryocclusion. Evaluation second day after the determination limb ABI, after the firstone,3,6,12and18months lower extremity arterial ultrasound or CTA and observelocal wound repair, with or without amputation were evaluated.Three months ofpreoperative and postoperative ankle-brachial index (ABI) paired t-test statisticalanalysis and to P <0.05indicates significant difference.Results:The study group treated27limbs (21patients) or PTAS PTA line of surgicalsuccess rate was88.9%(24/27), a simple treatment of three limbs PTA, PTA plusstenting treatment of21patients forming limb, into self-expanding nitinol stent57.Under9revascularization using endometrial open the target artery occlusion;15were treated by the true lumen. Successful operation of24limbs had22limbs werefollowed up for a mean of12months (6-18months) follow-up rate was91.7%(22/24), dorsal artery ankle-brachial index (ABI) of0.39before surgery±0.14afterthree months rose to0.86±0.19(t=2.712, P <0.01); posterior tibial artery ABIincreased from0.45±0.12preoperatively to three months after0.90±0.10,(t=2.683, P <0.01); limb ischemia symptoms improved significantly.6months afterarterial patency rate was83.3%(20/24), limb salvage rate was95.8%(23/24);12months after arterial patency rate77.3%(17/22), limb salvage rate of86.4% (19/22). All patients without arterial rupture, blood clots and other complicationsrelated to the operation.3/27is not successful, in which a superficial femoralartery calcification due to severe lesions failed to pass a guide wire segment;another two appeared during surgery vagal reflex, the patient had transient heart rate,blood pressure dips terminated surgery.Conclusions:For elderly TASC Ⅱ C, D type LEAOD total occlusion, endovascular therapyis a minimally invasive, safe and effective treatment, you can quickly restore bloodflow in the lower limb, lower limb ischemia improve symptoms, improve physicalsurvival. Subendometrial approach selection and revascularization techniques is thekey to improve the success rate of short-term clinical results were satisfactory...