Iliac artery occlusion

Iliac artery occlusion is a very common type of lower limb arteriosclerosis. The patients are mainly the elderly. It not only makes the elderly's physical fitness worse and their immunity reduced, but also makes their lives very inconvenient, especially making it very difficult to move, which greatly affects their quality of life. So, what should we do if the iliac artery is occluded?

As the population ages, there are more and more cases of lower limb arteriosclerosis. In the past, traditional surgical bypass surgeries have become less and less common, while more and more people have used interventional methods to open lower limb artery occlusions. For short-segment occlusions of the lower limbs, that is, TASC stage A and B cases, interventional methods have become a routine method. However, the difficulty lies in the long-segment occlusion of the iliac femoral artery or the occlusion of the superficial femoral artery opening, which is the clinical difficulty. This article focuses on the method of recanalizing long-segment occlusion of the superficial iliofemoral artery.

To sum up, there are five methods:

1. Direct opening method

For cases of iliac artery or one-sided superficial femoral artery occlusion, selding puncture and reverse vascular direction into the abdominal aorta for angiography can be used to understand the occlusion of bilateral iliac arteries and superficial femoral arteries. The C2 catheter combined with the guidewire can be used to enter the iliac artery on the affected side in an antegrade manner, and the replacement of the transcatheter sheath can easily achieve treatment of the femoral artery on the stenotic side of the lesion. As long as the guidewire passes through the occlusion on the stenotic side, balloon dilatation and stent implantation will be relatively smooth. Most clinical cases are completed using this method.

2. Reverse opening method

After the sheath or catheter enters the extracorporeal artery on the narrowed side of the lesion, how to enter the superficial femoral artery is another key issue. In some cases, the superficial femoral artery is completely occluded without even a small protrusion, and the guidewire will only enter the deep femoral artery. At this time, we need to try to get the catheter guidewire into the starting point of the superficial femoral artery. In clinical practice, sometimes the guidewire blindly penetrates into the subintima of the occluded superficial femoral artery, and it is difficult to enter the true lumen of the femoral artery all the way down. In this case, Yuanrui retrograde puncture is our choice: perform Lutu angiography in the lower superficial femoral artery to understand the location of the distal superficial femoral artery, and use a micropuncture needle to percutaneously puncture the lower end of the Lutu femoral artery in the lower thigh. After patient puncture, especially with the cooperation of B-ultrasound, it can usually be successful. The catheter and guide wire are raised from the distal end of the femoral artery to the proximal end, and most of them can enter the true lumen of the femoral artery. We call it retrograde puncture.

3. Thrombolytic opening technology

In cases of long femoral artery segments, sometimes the occlusion is so long that one might think that many stents need to be placed, but the guide wire can easily enter the occluded segment. Combined with the medical history, this situation is thrombosis occurring on the basis of arteriosclerosis. It is not suitable to lay the support in long sections. A thrombolytic catheter should be left in place to dissolve the thrombus for 3 to 5 days, and then lower limb artery angiography should be performed. It can be seen that most of the stenotic segments are open, and only a few stents need to be placed in the severe stenosis.

4. Hybridization method launched

It refers to the number of stenotic lesions opened by a combination of open surgery and interventional methods. For example, if the bilateral femoral arteries are blocked throughout, we first use the interventional retrograde puncture method to open the occluded femoral artery on one side, and then perform left and right femoral artery bypass grafting, simplifying the open surgery into an interventional surgery, and changing the other side's femoral artery surgery into a left and right femoral artery bypass grafting on the toe bones. This method simplifies the surgery, reduces trauma, and is worth learning from.

5. Surgical bypass

Most TASSC/D stage cases were approved, but there were still a few stubborn pathologies that could not be opened. In this case, we should make full use of the surgeon's surgical tools to perform direct autologous great saphenous vein bypass or artificial blood vessel bypass through open surgery to improve blood circulation. Never forget the main job of vascular surgeons - open surgery.