肢体缺血性疾病腔内治疗的现代策略

Modern strategy about endovascular surgery in the treatment of extremity ischaemia

目的探讨应用介入腔内治疗方法为首选,结合传统手术技术治疗肢体缺血性疾病的有效性。方法自2006年1月至2008年3月北京世纪坛医院血管外科应用介入腔内治疗方法为首选,结合传统手术技术治疗肢体缺血性疾病70例。其中年龄最大83岁,最小58岁,平均73岁。男女比例为4∶1。70例中80%有间歇性跛行,跛行最近距离20m,30%有静息痛,10%足溃疡及坏死。全部病例入院后进行了肢体血管超声、MRA、血管造影检查和踝肱指数(ABI)测定,其中63例(90%)有两个部位以上的动脉狭窄或闭塞病变,56例(80%)累及膝关节以下。治疗前ABI平均为0.58。全部70例病人进行了腔内治疗同时辅助传统的手术技术。结果腔内手术成功率92%,90%病人得到不同程度的改善,其中疗效达到优秀为39例(56%)、良好为28例(40%)、一般为3例(4%)无不良和死亡病例。手术并发症发生率为7%,治疗后ABI平均为0.90,平均增长了0.32。1年通畅率为86%,再狭窄率为6%,二次处理1年通畅率为90%。结论介入腔内治疗方法做为首选,结合传统手术技术能有效的治疗肢体缺血性疾病,同时具有创伤小、恢复快、并发症少、反复应用的优点,值得推荐。

Objective To probe into the usefulness as the first - choice by endovascular surgery in the treatment of extremity ischaemia. Methods Methods From January 2006 to March 2008,70 patients of extremity ischaemia were treated by endovascular surgery with combine traditional surgery as the first-choice at Beijing Shijitan Hospital. The age range was from 58 to 83 years and the mean was 73 years. Male with Female was 4：1. In all 70 patients,there were claudication at the 80% and the most short distance was 20m,rest pain at the 30% ,ulcer and necrosis of foots at 10a%. All 70 patients were examinated by extremity vascular ultrasound, MRA, angiography and ABI. Stenosis or occlusion of vascular at more than two sites were occurred in 63 patients （90%） and below articular genu in 56 patients（80% ）. The mean ABI was 0. 58 before the treatment. Results The success rate of treatment was 92% in all 70 patients. There were excellent at 39 （56%） patients, good at 28 （40%）patients, general at 3 （4%） patients and neither bad nor death patients. Complication incidence was 7%. The mean ABI was 0. 90 after treatment and increased 0. 32. One year＇ s patency rate was 86% ,and restenosis incidence was 6%. Conclusion Endovascular surgery as the first choice combined with traditional surgery revascularis.ation procedure is feasible,safe and effective for treatment of extremity ischaemia. It can be repeated in most cases successfully. Complications and restenosis are infrequent events. It is worthy of being recommendation in clinical.