微球囊血管腔内成形术治疗膝下动脉闭塞性疾病

Percutaneous transluminal angioplasty with microballoon in the treatment of infrapopliteal artery occlusive disease

目的观察微球囊血管腔内成形术治疗膝下动脉闭塞性疾病的疗效。方法对采用微球囊血管腔内成形术治疗的32例(37条肢体)膝下动脉闭塞性疾病患者的临床资料进行回顾性分析。按Fontaine分期:Ⅲ期22条患肢(59.5%),Ⅳ期15条患肢(40.5%)。术前踝/肱指数(ABI)为0.22±0.20。结果技术成功35条肢体,成功率94.6%。35条肢体中术后静息痛消失21条肢体(60.0%),明显缓解12条肢体(34.3%),减轻2条肢体(5.7%);8例足部溃疡患者中愈合3条肢体,缩小5例。膝下截肢1条肢体,半足切除2条肢体。术后ABI0.73±0.21,较术前有显著提高(P<0.01)。手术成功的35条肢体均行术后随访,随访时间1～29个月,平均13.6个月。随访中2条肢体分别于术后6,14个月再次出现静息痛,经二次经皮血管腔内成形术(PTA)治疗后症状消失;其余33条肢体症状、体征均无加重或复发。结论微球囊血管腔内成形术治疗膝下动脉闭塞性疾病安全可行,且创伤小、恢复快、近期疗效确切。远期效果有待进一步观察。

Objective To evaluate the effect of pereutaneous transluminal angioplasty （PTA） with microballoon for patients with infrapopliteal artery occlusive disease, Methods The clinical materials of 32 cases （37 limbs ） with infrapopliteal artery occlusive disease treated by PTA with microballoon were retrospectively studied. According to Fontaine staging, 22 limbs （59.5%） were in stage Ⅲ and 15 limbs （40.5%） in stage Ⅳ. Preoperative ABI was 0.22 ± 0.20. Results The technical success rate was of 94.6 % （35 limbs ）. Of these limbs, rest pain disappeared in 21 limbs （66.0 % ） and clinical symptoms were relieved obviously in 12 limbs （34.3 % ）. Of the preoperative foot ulcers in 9 limbs, 3 healed, Of the 6 limbs with foot or toe gangrene, 1 underwent below-knee amputation and 2 received partial foot amputation. The postoperative ABI was 0.73 ± 0. 21. All the 35 limbs with successful operation were followed up with an average period of 13.6 （1 -29 ） months. During follow-up, 2 limbs had recurrence of rest pain at 6m and 14m after operation, respectively; and the symptoms were relieved after a second PTA. The signs and symtpoms in the other 33 limbs did not increase or recur. Conclusions PTA with microballoon is a feasible technique in the treatment of infrapopliteal artery occlusive disease, especially in poor risk patients. Long-term results need to be further studied.