四、治疗

　　1. 保守治疗             

　　引起PAES的根本原因在于N动脉受到解剖性异常结构的压迫，因此常规的抗血小板，扩血管的保守治疗意义不大。对于明确有解剖异常的患者，积极的解除异常结构的压迫是治疗的关键。辽宁省人民医院肿瘤介入科周玉斌

　　2 腔内治疗

　　对于PAES患者中由于新鲜血栓形成所导致的N动脉闭塞，导管接触性溶栓治疗疗效较好，而由于长期压迫致使N动脉壁继发性纤维化和增厚而导致的N动脉闭塞者，溶栓治疗疗效差。对于经皮腔内血管成形术（PTA）和支架置入术，因术后N动脉仍处于受压状态，不能从病因上解除动脉压迫，且关节活动部位不宜支架置入，故不建议应用。

　　3 手术治疗

　　对于有症状的PAES病例，手术是绝对适应症，手术目的是重建N窝的正常解剖，恢复肢体血流[19]。常规手术入路是后位入路（N窝处的S-形切口），该入路的优点是可以完全暴露N动脉和周围结构。如果早期发现而血管无器质性病变，分离腓肠肌内侧头或其它的非正常肌束和肌腱，单纯松解N动脉即可，无需重建分离的肌肉。因术后易发生急性血栓形成，PAES病人不宜行血栓内膜剥脱术。N动脉已有病变者则应在切除相应压迫结构松解N动脉基础上行动脉重建术；N动脉狭窄后扩张形成动脉瘤者，应行动脉瘤切除，血管置换术，同时必须切除相应压迫结构。

　　4 预后

　　如果能够早期诊治，PAES的治疗预后较好。如果发现较晚，并发广泛的动脉损害，则预后不佳，可造成严重的间跛，甚至截肢。但是值得注意的是造成截肢的情况很罕见，因为PAES造成动脉闭塞通常是一个缓慢的进程，提供充足的时间允许侧枝循环形成。

　　结语

　　PAES是周围血管功能不全的少见但重要的原因。在年轻人急性N动脉闭塞、间跛或奇怪的腿部疼痛的鉴别诊断中要考虑到本病，特别是在年轻男性患者。早期诊断和外科治疗对于良好预后至关重要。通常通过影像学方法诊断此病，血管造影和CTA、MRA是诊断PAES的较有价值的检查方法[20]，但各有优劣，几种方法的联合应用更有利于确诊。N动脉松解术或联合静脉旁路术是有手术指证者的治疗选择。

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