PTA及支架在老年人下肢动脉硬化性闭塞中的临床应用

Clinical use of PTA and stent implantation for the treatment of atherosclerosis obliterans of lower extremities in elderly patients

目的探讨老年人下肢动脉硬化性闭塞(ASO)腔内治疗手术的疗效。方法老年下肢ASO患者56例,分为腔内治疗组和药物治疗组。药物治疗组33例患者48条下肢,予阿加曲班静脉滴注2 w,波立维、培达长期口服,3月后低分子肝素皮下注射10 d。腔内治疗组23例患者33条下肢,予球囊扩张(PTA)及选择性股动脉支架置入治疗,术后给予药物治疗组相同药物治疗。治疗6月后比较两组踝肱指数(ABI)和间歇性跛行、下肢疼痛麻木感、坏疽溃烂改善程度。结果治疗后ABI改善程度,A组有统计学意义,B组无统计学意义。间歇性跛行、下肢疼痛麻木感、坏疽溃烂改善程度方面A组均优于B组。下肢疼痛麻木感、坏疽溃烂改善有效率A组和B组有统计学意义。结论PTA及支架置入手术治疗老年人下肢ASO是安全有效的腔内治疗方法。

Objective To evaluate the curative effect of percutaneans transluminal angioplasty（ PTA ）and stent implantation for the treatment of atherosclerosis ohliterans （ ASO ）of lower extremities in elderly patients. Methods Elderly ASO patients who were admitted in this department from January 2004 to June 2006 were divided into two groups： group A were patients who received endovaseular therapy, and group B were patients who received medical treatment. Medical treatment of the 23 patients （33 limbs） in group B included intravenous Argatroban for two weeks, long-term rise of Clopidogrel Sulfate and Cilostazol, and plus subcutaneous injection of low molecular weight heparin calcium for 10 days three months later. Surgical treatment of the 33 patients （48 limbs） in group A included PTA and selective stent implantation, and postoperative use of the same drugs as group B. Six mouths after treatment, ankle brachium index （ABI）, pain and numbness during intermittent claudication of the lower extremities, and improvement of sloughing ulcer were compared between the two groups. Results Favorahle change of ABI after treatment was statistically significant in group A, and insignificant in group B. Improvement in intermittent clandication, pain and numhness of the lower extremities and ulcerative erosion was better in group A than that in group B, There was significant difference in improvement of pain,numbness and ulcerative erosion of the lower extremities hetween the two groups. Conclusions PTA and stent implantation is a safe and effective intraluminal treatment for ASO of the lower extremities in elderly patients.