经皮介入治疗下肢动脉阻塞136例分析

Outcome of endovascular therapy of iliac,superficial femoral and popliteal arteries in 136 patients

目的评估下肢动脉严重狭窄患者经皮球囊成形术或选择性支架置入术的近中期临床疗效和安全性。方法连续136例下肢严重间歇性跛行或慢性缺血的患者,病因均为动脉粥样硬化,其中髂动脉阻塞81例,股浅动脉阻塞43例,腘动脉阻塞12例,所有病变首先均进行经皮球囊成形术,如果有夹层或残余狭窄>30%,则置入支架。随访1年,在6个月和12个月时评估再狭窄和临床疗效。结果共进行36例经皮球囊成形术和99例选择性支架置入术。术前病变狭窄程度70%～100%(88.6%±7.5%),狭窄长度1.5～18.0 cm[(6.2±2.9)cm],治疗节段2.0～19.0 cm[(7.3±3.2)cm],术后残余狭窄0%～30.0%(8.7%±5.1%)。手术相关的并发症2例。6个月随访发现,再狭窄率在髂动脉、股腘动脉和所有病变分别为7.3%、19.4%和12.3%,球囊成形术组和支架置入术组再狭窄率分别为17.8%比10.2%(P>0.05);12个月随访发现,再狭窄率在髂动脉、股腘动脉和所有病变分别为12.5%、29.9%和19.6%,球囊成形术组和支架置入术组再狭窄率分别为28.9%比16.1%(P>0.05)。但6 min 最大步行距离和踝肱收缩压比球囊成形术组均显著小于支架置入术组(P<0.001)。12个月随访期间发生急性心肌梗死3例和小卒中2例,无死亡病例。结论经皮介入治疗下肢动脉阻塞安全有效。中期疗效显示,选择性支架置入术组的再狭窄率与球囊成形术组相当,但6 min 最大步行距离和踝肱收缩压比优于球囊成形组。

Objective To evaluate the effect and clinical outcome of balloon angioplasty or selected stent implantation in patients with severe lower limb artery disease. Methods A total of 136 consecutive patients who had severe claudication or chronic limb ischemia due to atherosclerotic stenosis or occlusion of the iliac （ n = 81 ） , superficial femoral （ n = 43 ） and pepliteal （ n = 12 ） arteries underwent balloon angioplasty initially and selected stent implantation was followed in cases of dissection or more than 30% residual stenosis after balloon angioplasty （ n = 99 ）. Restenosis and clinical outcomes were assessed at 6 months and 12 months. Results Baseline mean （ ± SD） lesion length ranged from 1.5 cm - 18. 0 cm [ （6. 2 ±2. 9） cm] and stenosis ranged from 70% - 100% （88. 6% ±7.5% ）. The mean length of treated segments was 2. 0 cm - 19.0 cm [ （7.3 ±3.2） cm], and residual stenosis after procedure was 0% -30% （8.7% ±5. 1% ）. There were two procedure-related thrombosis complications and patients recovered pest related treatments. At 6 months, the rates of restenosis were 7.3% in iliac lesions, 19.4% in femoropepliteal lesions and 12. 3% in all lesions, 10. 2% in the stent group and 17.8 % in the balloon angioplasty group, respectively （ P 〉 0. 05 ） and revascularization was performed in 10 patients; at 12 months, the rates of restenosis were 12. 5% in iliac lesions, 29. 9% in femoropopliteal lesions and 19. 6% in all lesions, 16. 1% in the stent group and 28.9 % in the balloon angioplasty group （P 〉 0. 05）, respectively. Six-minute walk distance was significantly longer and ankle brachial index （ABI） was significantly higher at 6 months and 12 months in the stent group compared to balloon angioplasty group （ all P 〈0. 001 ）. All patients are alive and 3 acute myocardial infarction and 2 minor stroke were observed during 12 months follow-up. Conclusions Endovascular therapy in the iliac, superficial femoral and popliteal artery was safe and effective. The rate of restenosis in the stent group was comparable to that in balloon angioplasty group during 12 months follow up. Stent implantation is superior to balloon angioplasty in terms of six-minute maximal walk capacity and ABI during 12 months follow up.