膝下动脉经皮腔内血管成形术治疗糖尿病下肢缺血

Balloon angioplasty of infrapopliteal artery in chronic lower limb ischemia with diabetes

目的探讨经皮腔内血管成形术(PTA)治疗糖尿病下肢膝下血管病变的技术成功率、手术方式、围手术期并发症及其防治。方法回顾分析我院2006年1月至2007年5月行介入治疗的糖尿病下肢缺血病变患者27例,分析其术前术后临床症状改善情况,包括Rutherford-Becker分级以及踝肱指数。对不同病变类型及不同球囊的技术成功率进行比较,并分析术中术后并发症的发生情况,初步探讨防治方法。结果27例患者中24例术后临床症状有不同程度改善,3例手术失败。狭窄性病变和闭塞性病变的开通结果不同,χ2分析P<0.01;选用较短的冠脉球囊和长的膝下专用球囊对病变的开通情况经fisher精确概率法χ2检验P=0.024,两者比较差异有统计学意义。术中并发症主要有急性血栓形成、导丝穿破血管壁、斑块脱落及管壁夹层等,根据情况给予了相应处理。结论PTA是治疗糖尿病下肢缺血性病变的理想选择,术前对患者下肢动脉情况进行认真评估,制订合理的手术方案,对于手术的成功至关重要。

Objective To evaluate the technique, successful rate and perioperative complications together with the therapy and prevention of using PTA in treating diabetic patients with infrapopliteal arterial diseases. Methods Angiographic and clinical data of 27 patients with diabetic lower limb ischemia treated by PTA from January 2006 to May 2007 were retrospectively reviewed. Rutherford-Becker categories and anklebrachial index（ABI）were evaluated before and after the treatment. The effects were compared between different lesion types （stenosis or occlusion）and between different ways of balloon technique. The complications were also analyzed, together with the primary discussion of the therapy and prevention. Results 24 patients showed improvement of ischemic symptoms, and 3 cases fell in failure. The intra-procedural main complications included acute thrombosis, vascular wall perforation, distal emboli resulting from plaque falling off and dissection. There were statistically significant differences between the effects of two type lesions and between different balloon methods. Conclusions 1. The condition of lower limb arteries should he assessed carefully before operation. 2. PTA shows safe and good clinical result and ought to be recommended in treating diabetic patients with peripheral arterial diseases, especially the lower extremity ischemia.