胫腓动脉血管成形术治疗下肢严重缺血35例

Percutaneous transluminal angioplasty of tibioperoneal arteries for severe limb ischemia

目的评价胫腓动脉经皮血管腔内成形术（percutaneous transluminal angioplasty，PTA）治疗下肢严重缺血的可行性、安全性和有效性。方法对2004年6月至2007年5月收治的35例胫腓动脉闭塞的下肢严重缺血（critical limb ischemia，CLI）患者应用PTA治疗。评价的主要参数为：胫腓动脉PTA技术成功率、通畅率、救肢率和并发症。结果胫腓动脉PTA的技术成功率为83％，平均随访11．5个月，通畅率为57％，救肢率82％。胫腓动脉平均扩张长度9．5cm（4．5～14cm），19例患者同时行髂或股胭动脉PTA或支架术。有3例并发症发生，其中1例动脉痉挛和血栓形成，经溶栓、解痉等治疗缓解；2例动脉穿孔，未有严重后果。结论PTA治疗CLI合并胫腓动脉闭塞具有较高技术成功率和救肢率，较少发生严重并发症，是一种安全、有效可供选择的治疗方法。

Objective The purpose of this study was to assess the technical feasibility, safety and effectiveness of percutaneous transluminal angioplasty （PTA） for the treatment of severe limb ischemia caused by tibioperoneal arteries occlusion. Methods From June 2004 to May 2007, 35 patients with critical limb ischemia （CLI） were treated on an intention-to-treat basis with tibioperoneal arterial PTA. Main outcome measures were technical success rate, primary patency rate, limb salvage rate and complications. Results The technical success rate of tibioperoneal arterial PTA was 83%. Mean follow-up time was 11.5 months, primary patency rate and limb salvage rate were 57% and 82%, respectively. Mean length of tibioperoneal arterial PTA was 9. 5 cm（4. 5 - 14 cm）, concurrent treatment of iliac artery or femoral-popliteal artery was carried out in 19 patients via either angioplasty or combined with stenting. There were three complications including arterial spasm and thrombosis in one, which was relieved by thrombolysis and antispasmodics, and artery perforation in 2 eases, which was treated conservatively. Conclusion In tibioperoneal arterial occlusions in CLI patients, PTA is feasible with a high initial technical success rate and high limb salvage rate, tibioperoneal arterial PTA carries a lower morbidity and less severe complications. PTA is a safe, effective and good treatment alternative for CLI patients of tibioperoneal arterial occlusions.