膝下动脉腔内成形术治疗严重下肢缺血

Infrapopliteal artery endoluminal angioplasty for the treatment of severe limb ischemia

目的观察膝下动脉腔内成形术治疗严重下肢缺血的疗效。方法对2004年10月至2006年5月采用腔内成形术治疗的41例患者共48条患肢的资料进行回顾性分析。26条患肢有静息痛（54．2％）；9条患肢发生足部溃疡（18．7％），13条患肢合并有足趾或足部组织坏疽（27.1％）。19条患肢踝肱指数（ankle／brachial index，ABI）为0，22条患肢在0．1—0．5之间，7条患肢在0．51—0．6之间。结果技术成功率为93．8％。术后33条患肢疼痛缓解（73．3％），其中27条患肢无疼痛（64．3％）。10条患肢症状减轻（22．2％），其中3条复发。足部溃疡的9条患肢中，1条患肢足部小溃疡愈合。13条足趾或足部组织坏疽的患肢，2条行膝下截肢，2条行半足截除。24条患肢术后ABI增加0．5以上，12条增加0．31—0．5，7条增加0、1—0．3。42条患肢被随访，随访率为93．3％；时间平均为8、5个月（1—18个月）。本组共截肢5条患肢，总救肢率为88．1％。结论膝下小动脉腔内成形术在无法接受动脉旁路移植的严重下肢缺血的患者可以作为首选治疗方法。

Objective To evaluate belowknee arterial endoluminal angioplasty for the treatment of severe limb ischemia. Method Forty-one patients （48 limbs） of severe ischemia of the lower extremities from October 2004 to May 2006 were retrospectively studied. Of these ischemic limbs, 26 limbs（54. 2% ） , 9 limbs （18.7%） and 13 limbs （27.1%） suffered from rest pain, foot ulcer and foot or toe gangrene respectively. ABI was 0, 0. 1 - 0. 5 and 0. 51 - 0. 6 in 19 limbs, 22 limbs and 7 limbs respectively. Results The success rate of operation was 93.8%. Pain relieved in 33 （73.3%） limbs, reduced in 10 （22.2%） limbs. Of the preoperative foot ulcers in 9 limbs, one healed. Of the 13 limbs with foot or toe gangrene, 2 underwent belowknee amputation, 2 underwent partial foot amputation. Increase of ABI was more than 0. 5 in 24 limbs, 0. 31 -0. 5 in 12 limbs, 0. 1 -0. 3 in 7 limbs. Forty-two （93.3%） limbs were followed up with an average period of 8.5 （ 1 - 18） months. Of the 33 immediate pain-relieved limbs, 27 （64.3%） remained free of pain, while pain regained in 3 limbs out of 10 pain-reduced limbs. Five limbs underwent amputation with a limb salvage rate of 88. 1%. Conclusions Belowknee arterial endoluminal angioplasty is a feasible method for severe ischemia of the lower limb, especially in poor risk patients.