Rotarex旋切导管在股腘动脉狭窄合并血栓形成中的应用

doi:10.19723/j.issn.1671-167X.2023.02.018

摘要/Abstract

摘要：

目的: 探讨Rotarex旋切导管在治疗股腘动脉狭窄合并血栓形成中的有效性和安全性。方法: 回顾性分析2017年6月至2019年12月应用Rotarex旋切导管治疗的32例股腘动脉狭窄合并血栓形成患者的临床资料，其中男性23例，女性9例，年龄50~89岁，平均(70.7±10.3)岁；急性病程者6例(≤2周)，亚急性病程者17例(>2周且≤3个月)，慢性病程者9例(>3个月)；病变平均长度(23.4±13.7) cm，闭塞长度(19.9±13.3) cm；支架内闭塞者7例；病变位于股浅动脉者13例，腘动脉者8例，同时累及股浅及腘动脉者11例。所有患者均应用Rotarex旋切导管行减容治疗，必要时结合大腔导管抽吸取栓。残余狭窄同期行腔内成形术，经济状况允许者应用药物涂层球囊(drug-coated balloon，DCB)，必要时植入支架。术后肝素抗凝24 h，随后抗血小板治疗，定期彩色超声复查随访。结果: 32例患者均血运重建成功，技术成功率100%，平均手术时间(107.4±21.5) min。应用8F(1F≈0.33 mm)旋切导管27例，6F旋切导管5例; 27例经旋切导管减容后即刻获得正向血流，5例结合大腔导管抽吸。所有患者均行动脉腔内成形术，8例应用DCB再次扩张，其中4例用于支架内再狭窄病变; 12例患者植入支架。围术期无死亡病例；术中并发症1例，为远端动脉栓塞。该组患者平均住院时间(4.6±1.5) d，出院时踝肱指数平均值为0.86±0.10，较术前(0.32±0.15)明显改善(t=-16.847，P < 0.001)，Rutherford分级亦较术前明显降低(Z=-4.518，P < 0.001)。随访6~36个月(中位随访时间16个月)，随访期间2例患者因停用抗血小板药物发生靶血管急性闭塞，其中1例再次血运重建，2例死于心血管疾病，无截肢病例。7例患者随访期间超声提示靶病变再狭窄大于50%，其中1例为应用DCB患者，其余6例为未应用DCB患者，包括2例再次行腔内治疗。结论: 应用Rotarex旋切导管治疗股腘动脉狭窄合并血栓形成，能够有效清除血栓，暴露基础病变，减少支架的使用，且并发症发生率低，是一种安全有效的方法。

关键词: 闭塞性动脉硬化, 股腘动脉, 血栓形成, 血栓切除术

Abstract:

Objective: To evaluate the effectiveness and safety of Rotarex catheter system in treating femoropopliteal artery stenosis accompanied with thrombosis. Methods: From Jun. 2017 to Dec. 2019, the clinical data of 32 femoropopliteal artery stenosis accompanied with thrombosis cases treated with Rotarex catheter system were retrospectively analyzed. There were 23 males and 9 females aged from 50 to 89 years and the mean age was (70.7±10.3) years. Six cases had acute course of disease (≤2 weeks), 17 cases had subacute course of disease (>2 weeks, ≤3 months), and 9 cases had chronic course of disease (>3 months). Mean lesion length was (23.4±13.7) cm, mean occlusion length was (19.9±13.3) cm, and in-stent occlusion 7 cases. The superficial femoral artery (SFA) was involved in 13 cases, the popliteal artery (PA) was involved in 8 cases, and both SFA and PA were involved in the other 11 cases. All the cases were treated with Rotarex catheter system. When necessary, suction with large lumen catheter was enabled. Residual stenosis was treated with percutaneous transluminal angioplasty (PTA). Drug-coated balloon (DCB) was only used in patients with financial status, and stent was used only when it was necessary. Heparin was used for 24 h after procedures, and after that, antiplatelet agents were used. Doppler ultrasonography was taken during the followed-up. Results: Technical success was 100%, and mean procedure time was (107.4±21.5) min. 8F (1F≈0.33 mm) and 6F Rotarex catheter were used in 27 and 5 cases respectively. In 27 cases, forward flow was obtained immediately after debulking with Rotarex catheter, and in the other 5 cases, suction with large lumen catheters were used. PTA was used in all 32 cases. DCB were used in 8 cases, of which 4 were used in in-stent stenosis. Twelve cases were implanted stents. There were no perioperative deaths. The only one procedure related complication was distal embolism. We took out the thrombus with guiding catheter. In all cases, mean hospital stay were (4.6±1.5) d. The ankle brachial index increased from 0.32±0.15 to 0.86±0.10 after treatment (t=-16.847, P < 0.001). The Rutherford stages decreased significantly (Z=-4.518, P < 0.001). All the patients were followed up for 6.0-36.0 months, and the median time was 16.0 months. 2 cases stopped antiplatelet agents, which resulted in acute thrombosis. Another percutaneous mechanical thrombectomy and PTA were taken in one of them. Two cases died of cardiovascular disease during the follow-up, and no amputation was observed. Target lesion restenosis occurred in 7 cases during the follow-up, and target lesion revascularization (TLR) was taken in two of them. Conclusion: In treating femoropopliteal artery stenosis accompanied with thrombosis, Rotarex catheter can remove thrombus effectively, and that can expose underlying lesions and reduce stent use and complications rates. It is a safe and effective method.

Key words: Arteriosclerosis obliterans, Femoropopliteal artery, Thrombosis, Thrombectomy

中图分类号:

R654.3

庄金满,李天润,李选,栾景源,王昌明,冯琦琛,韩金涛. Rotarex旋切导管在股腘动脉狭窄合并血栓形成中的应用[J]. 北京大学学报（医学版）, 2023, 55(2): 328-332.

Jin-man ZHUANG,Tian-run LI,Xuan LI,Jing-yuan LUAN,Chang-ming WANG,Qi-chen FENG,Jin-tao HAN. Application of Rotarex catheter system in femoropopliteal artery stenosis accompanied with thrombosis[J]. Journal of Peking University (Health Sciences), 2023, 55(2): 328-332.

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参考文献 13

1	姜国忠, 李雪岩, 赵健飞, 等. 血栓旋切器联合药物涂层球囊治疗股腘动脉继发血栓的体会[J]. 血管与腔内血管外科杂志, 2018, 4 (2): 129- 131.
2	Johnston KW . Femoral and popliteal arteries: Reanalysis of results of balloon angioplasty[J]. Radiology, 1992, 183 (3): 767- 770. doi: 10.1148/radiology.183.3.1294068
3	Banerjee S , Sarode K , Mohammad A , et al. Femoropopliteal artery stent thrombosis: Report from the excellence in peripheral artery disease registry[J]. Circ Cardiovasc Interv, 2016, 9 (2): 1- 12.
4	Lichtenberg M . Percutaneous mechanical thrombectomy by means of rotational thrombectomy. Current study situation[J]. Med Klin, 2010, 105 (10): 705- 710. doi: 10.1007/s00063-010-1122-0
5	Kronlage M , Printz I , Vogel B , et al. A comparative study on endovascular treatment of (sub)acute critical limb ischemia: Mechanical thrombectomy vs thrombolysis[J]. Drug Des Devel Ther, 2017, 11, 1233- 1241. doi: 10.2147/DDDT.S131503
6	Heller S, Lubanda JC, Varejka P, et al. Percutaneous mechanical thrombectomy using Rotarex^Ⓡ S device in acute limb ischemia in infrainguinal occlusions[J/OL]. Biomed Res Int, 2017, 2017: 2362769.
7	Ouriel K , Veith FJ , Sasahara AA . A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or peripheral arterial surgery (TOPAS) investigators[J]. N Engl J Med, 1998, 338 (16): 1105- 1111. doi: 10.1056/NEJM199804163381603
8	Darwood R , Berridge DC , Kessel DO , et al. Surgery versus thrombolysis for initial management of acute limb ischaemia[J]. Cochrane Database Syst Rev, 2018, 8 (8): CD002784.
9	Hage AN , McDevitt JL , Chick JFB , et al. Acute limb ischemia therapies: When and how to treat endovascularly[J]. Semin Intervent Radiol, 2018, 35 (5): 453- 460. doi: 10.1055/s-0038-1676321
10	李宏伟, 罗字东, 范海伦, 等. 经皮机械血栓清除术治疗下肢动脉狭窄伴血栓形成病变的近期疗效观察[J]. 天津医科大学学报, 2017, 23 (5): 430- 433.
11	Veenstra EB , van der Laan MJ , Zeebregts CJ , et al. A systematic review and meta-analysis of endovascular and surgical revascula-rization techniques in acute limb ischemia[J]. J Vasc Surg, 2020, 7 (12): 654- 668.
12	Liu J , Li T , Huang W , et al. Percutaneous mechanical thrombectomy using Rotarex catheter in peripheral artery occlusion diseases: Experience from a single center[J]. Vascular, 2019, 27 (2): 199- 203. doi: 10.1177/1708538118813239
13	Latacz P , Simka M , Brzegowy P , et al. Mechanical rotational thrombectomy with Rotarex system augmented with drug-eluting balloon angioplasty versus stenting for the treatment of acute thrombotic and critical limb ischaemia in the femoropopliteal segment[J]. Wideochir Inne Tech Maloinwazyjne, 2019, 14 (2): 311- 319.

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Variables	Value
Age/years	70.7±10.3
Gender, male/female	23/9
Course of disease, acute/subacute/chronic	6/17/9
Lesion length/cm	23.4±13.7
Occlusion length/cm	19.9±13.3
In-stent restenosis	7
Lesion locations, SFA/PA/SFA and PA	13/8/11
Patent tibial/peroneal artery 0/1/2/3	3/7/12/10
Hypertension	23
Diabetes mellitus	12
Hyperlipidemia	9
Coronary artery disease	7
Cerebral infarction	7
Smoking	17
Rutherford stages 0/1/2/3/4/5/6	0/0/0/14/13/5/0
ABI	0.32±0.15

Variables	Value
Procedural success	32 (100)
Procedural time/min	107.4±21.5
Adjunctive aspiration with guiding catheter	5 (15.6)
PTA	32 (100)
DCB	8 (25.0)
Stent (1 stent/2 stent)	11/1 (37.5)
Procedure related complications	1 (3.1)
Perforation	0
Distal embolism	1 (3.1)
Acute occlusion	0
ABI after treatment	0.86±0.10
Rutherford stage after treatment 0/1/2/3/4/5/6/	7/12/5/2/1/5/0
Hospital stay/d	4.6±1.5
Follow-up time/months	16 (6-36)
Death	2 (6.3)
Amputation	0
Acute occlusion	2 (6.3)
Restenosis	7 (21.9)
TLR	3 (9.4)

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