血管腔内成形术治疗膝下动脉硬化闭塞症的临床研究

A study on percutaneous transluminal angioplasty for the treatment of the patients with below-the-knee arteriosclerosis obliterans

目的评价腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗膝下动脉闭塞性疾病的临床疗效。方法回顾性分析病变位于膝下(below-the-knee,BTK)合并严重肢体缺血(critical limb ischemia,CLI)的动脉硬化闭塞症患者行PTA治疗的临床效果;测量患者治疗前后的踝肱指数(ankle branchial index,ABI)。分别对技术成功率、保肢率和一期通畅率进行统计学分析;并统计患者术后30天的穿刺部位、介入治疗部位和全身的相关并发症。结果共治疗33例(58条肢体)。全组术前ABI平均值为0.24±0.04,术后9天为0.76±0.03。其技术成功率为94.8%,保肢率为87.9%;6个月、1年的一期通畅率分别为72.6%及49.1%;本组患者无围手术期死亡,术后并发症发生率为12.1%。结论 PTA治疗合并严重肢体缺血的膝下动脉硬化闭塞症是可行、安全、有效的措施。推荐PTA作为首选的治疗方法,但其长期疗效有待进一步观察。

Objective To evaluate the clinical results of percutaneous transluminal angioplasty (PTA) for the treatment of the patients with below-the-knee arteriosclerosis obliterans. Methods A retrospective study were performed for the patients with arteriosclerosis obliterans (ASO ) complicated by critical limb ischemia (CLI) in whom the lesions limited to below-the-knee(BTK )arteries and the ankle branchial index(ABI) of the patients were measured before and after operation. The successful rate, the rate of limb savage, and primary patency rate were evaluated and the access site, intervention site, and systemic complications at postoperative 30-day were also evaluated.Limb savage, and primary patency rate were evaluated using the Kaplan-Meier method and compared with Fisher’s exact test. Results 33 patients with 58 limbs underwent PTA, of whom the average branchial index(ABI ) before operation is 0.24±0.04 and the average ABI increased to 0.76±0.03 at nineth postoperative day in this study. The successful rate was 94.8%and limb salvage rate was 87.9%. The primary patency was 72.6%and 49.1%respectively at postoperative 6-month, and at postoperative 1-year.There were no death rate during perioperative period and the postoperative complication rate was 12.10%.Conclusion PTA is a kind of feasible,safe and effective procedure for the treatment of the patients with below-the-knee arteriosclerosis obliterans.Therefore it could be recommended as the ifrst choice for the treatment of the patients with below-the-knee ASO.It will be wait for advance observation to conifrm the long term outcome.