DEEP球囊导管在膝下动脉腔内成形术治疗严重下肢缺血中的应用

Inferior knee arterial endoluminal angioplasty in treating severe lower limb ischemia though the DEEP balloon catheter

目的应用DEEP球囊导管膝下动脉成形术治疗严重下肢缺血的疗效分析。方法回顾性分析2007年8月至2008年4月采用膝下动脉成形术治疗11例患者17条严重缺血患肢的结果。所有患者均有静息痛,其中6条患肢合并溃疡(2条)或坏疽(3条)或两者同时存在(1条)。12条患肢踝肱指数(ABI)为0.2～0.5,5条患肢为0.51～0.7,平均0.47。结果手术技术成功率为100%,13条患肢疼痛明显缓解,2条肢体减轻,2条患肢疼痛无缓解而行膝关节以上截肢;有溃疡的2条患肢,溃疡愈合。有足趾坏疽的3条患肢,1条干性坏疽无变化,1条坏疽足趾脱落,1条行半足截除术后,创面愈合,同时伴有溃疡和坏疽的1条患肢,溃疡愈合,坏疽足趾脱落。10条患肢ABI增加超过0.5,5条增加0.3～0.5,2条无改变,平均值为0.83。10例患者16条患肢得到随访,平均随访时间4.3个月(1～9个月)。15条患肢疼痛明显缓解,其中12条无复发,3条复发,3条中2条再次行下肢动脉PTA后疼痛缓解,1条未行PTA治疗而行截肢。ABI平均值为0.70。结论应用DEEP球囊导管行膝关节以下动脉成形术治疗严重下肢缺血具有较高的成功率,短期随访有较好疗效,中长期疗效有待进一步观察。

Objective To evaluate the efficacy of inferior knee arterial endoluminal angioplasty for treating severe lower fimb ischemia with the use of the DEEP balloon catheter. Methods Eleven patients （17 limbs） with severe isehemia of lower extremities from August 2007 to April 2008 were retrospectively studied. All involved limbs suffered from rest pain including 6 limbs（6/17）eomplicated with ulcer, 2（2/17） with toe gangrene or 3 （3/17）with both of the complaints. ABI （Ankle brancial index） were 0.2 - 0.5 and 0.51 - 0.7 in 12 limbs and 5 limbs respectively, with average value 0.47. Results The success rate of operation was 100%（17/17）. Pain relieved obviously in 13 limbs（13/17） and reduced in 2 limbs（2/17）. 2 limbs （2/17） still suffered from pain and underwent upper-knee amputation and other 2 with ulcerations（2/ 17）were healed. 3 （3/17） with toe gangrene underwent partial foot amputation, 1 with dried gangrene remained unchanged and the other was lost. Another one showed ulcer healed and toe was lost. Increase of ABI was more than 0.5 in 10 limbs（10/17） and 0.3 - 0.5 in 5 limbs（5/17） With average value of 0.83. 10 patients with sixteen limbs were followed up in an average period of 4.3 months （1 - 9 months）. Of the 15 immediate pain-relieved limbs, 12 （12/15） limbs remained free of pain and pain recurred in 3 other limbs; and 2 of them with pain-reduced after PTA again; the other 1 underwent amputation, Average value of ABI was 0.70. Conclusions Inferior arterial endoluminal angioplasty for the treatment of severe limb ischemia with application of the DEEP balloon catheter show high successful rate and short-term encouraging clinical results but mid-term and long-terms follow up should be undertaken for further investigation.