糖尿病下肢动脉病变股深动脉形态学分析

Angiographic study of the deep femoral artery in diabetic patients with peripheral artery disease

目的通过数字减影下肢动脉造影,分析糖尿病性外周动脉病变中股深动脉的形态学特征,以期对糖尿病下肢缺血治疗方案和预后判断提供影像学评估。方法2型糖尿病(T2DM)患者50例。用分段积分法比较数字减影血管造影(DSA)所见股深动脉开口部位(A段)、股深动脉开口至旋股外侧动脉(B段)、旋外侧动脉至第二穿支(C段)、第二穿支至远端(D段)动脉管腔狭窄程度和各段病变发生率;根据股或腘动脉积分分为E(<3分)、F(≥3分)两组,比较两组股深动脉B段的管径。结果(1)A、B、C、D各段病变率明显不同,分别为3/95(3.1%)、17/94(18.9%)、57/94(60.6%)和74/97(78.7%)。(2)A、B、C、D各段血管积分分别为0.13±0.70、0.28±0.77、0.72±0.78和1.24±1.03,除A、B两段差异无统计学意义外,其余各段比较差异均有统计学意义。(3)E、F组股深动脉B段管径(mm)分别为5.43±0.36和5.40±0.52,差异无统计学意义(P=0.79)。结论糖尿病性下肢动脉病变.多累及旋股外侧动脉开口以远股深动脉分支,较少累及股深动脉开口部和旋股外侧动脉开口以近之血管主干;病变程度上股深动脉远段分支病变积分明显高于近段血管;当股腘动脉出现重度狭窄-闭塞时,股深动脉管径无明显变化。

Objective To study the characteristic manifestation of the deep femoral artery in diabetic patients with peripheral artery disease based on the angiogram. Methods 50 diabetic patients with occlusive peripheral arterial disease underwent digital subtraction arteriography（DSA） on lower-extremities. Stenoses in the artery peristome（ A group） ,the first segment（ B group） ,the second segment（ C group）, and the third segment（ D group） of the deep femoral artery were scored based on the artery stenosis ： 0 ,no stenosis ; 1 ,stenoses 〈50% ; 2,stenosis from 50% to 〈75% ,3,stenosis 75% to 〈 100% ,and 4,completely occlusion . The sum of the lesions assigned to the arterial sections was the angiographic score. Results The abnormal prevalences of the peristome,the first,second,and third segments of the deep femoral artery （DFA） were 3/95, 17/94,57/94 and 74/97, respectively,which were significantly different between intergroups. The mean （SD） angiographic scores in the peristome, the first segment, the second segment, and the third segment of the deep femoral artery were 0. 13 ±0. 70,0. 28 ±0. 77,0. 72±0.78 and 1.24 ±1.03 respectively. Statistical differences were found among different groups except between groups of A and B. No significant difference was found in the first segment diameter of DFA between groups of E and F. Conclusions 1. Compared with the peristome and the first segment,the second segment and the third segment of DFA are more often involved. 2. Stenosis is more severe in the distal deep femoral artery. 3. When stenoses of superficial femoral or popliteal arteries were 〉75% or 100% ,the diameter of the first segment of the deep femoral artery does not change.