介入技术治疗下肢动脉硬化闭塞症的效果研究

The Effect of Interventional Therapy on Arteriosclerosis Obliterans of Lower Extremity

目的探讨介入技术治疗下肢动脉硬化闭塞症的效果。方法选取2016年1月—2017年6月丽水市中心医院收治的下肢动脉闭塞症患者71例作为研究对象,根据不同病变部位及影像学特征,采用不同的穿刺入路应用内膜下再通技术开通闭塞段。观察患者再通效果与随访结果。结果经过介入治疗,患者下肢动脉闭塞再通成功率达到93.0%(66/71)。血管再通成功患者治疗后下肢症状即刻得到缓解,再通失败患者症状均未明显加重。治疗1周后,再通患肢踝肱指数(ABI)由治疗前(0.52±0.15)升高至(0.82±0.24)(P<0.05),Fotaine分级改善2级者43例,改善1级者23例。患者出院后随访1年,失访2例;术后6、9、12个月分别有2、6、5例复发,复发率为19.7%;13例复发患者中7例(10.6%)行2次介入治疗后好转,3例(4.6%)远端截肢,3例(4.6%)放弃治疗。结论结合复杂下肢动脉硬化闭塞症患者病情与影像特征选用合适的介入技术可有效促进下肢动脉闭塞再通,为复杂闭塞患者提供了一种安全有效的治疗手段。

Objective To explore the application effect and value of interventional therapy in patients with arteriosclerosis obliterans of lower extremity.Methods A total of 71 patients with arteriosclerosis obliterans of lower extremity treated in Lishui Central Hospital from January 2016 to June 2017 were selected as study objects.According to the location and imaging features of different lesions,occlusive segment with subintimal recanalization were opened by different puncture approaches.Effect of recanalization and follow-up results were observed.Results After interventional therapy,the success rate of revascularization of lower limb artery was 93.0%(66/71).After successful revascularization,the lower limb symptoms were immediately relieved,while the symptoms were not significantly worsened in the case of revascularization failure.After 1 week of treatment,ankle-brachial index(ABI)of the affected limb was increased from(0.52±0.15)before treatment to(0.82±0.24)(t=8.611,P<0.05).There were 43 cases of improving the grade 2 and 23 cases of improving the grade 1 of Fotaine.Patients were followed up for 1 year after discharge,and 2 patients were lost to follow-up.There were 2,6 and 5 cases of recurrence 6,9 and 12 months after surgery,with the recurrence rate of 19.70%.Among the 13 patients with recurrence,7(10.6%)got better after 2 times of interventional therapy,3(4.6%)had distal amputation,and 3(4.6%)gave up treatment.Conclusion Combined with the condition and imaging features of patients with complex arteriosclerosis obliterans of the lower extremities,appropriate interventional techniques can effectively promote the recanalization of arteriosclerosis obliterans of the lower extremities,it provide a safe and effective treatment for patients with complex occlusion.