腔内血管成形术治疗糖尿病膝下动脉长段闭塞病变的价值

Value of percutaneous transluminal angioplasty in treatment for diabetic patients with long segment obliterans of infrapopliteal artery

目的探讨经皮腔内血管成形术治疗糖尿病膝下动脉长段闭塞病变的临床疗效及价值。方法本组56例糖尿病膝下动脉长段闭塞病变患者,男34例,女22例,年龄48～76岁,中位年龄62岁。Fontaine分期,Ⅱb期(中至重度间歇跛行)19例,Ⅲ期(缺血性静息痛)21例,Ⅳ期(不同程度的溃疡和坏疽)16例。所有患者术前均行患肢CT血管造影及数字减影血管造影检查;术后定期门诊随访12个月,观察记录临床症状和体征变化;并于术前和术后1、3、6和12个月行患肢跛行距离、足趾皮温、踝肱指数(ABI)、趾肱指数(TBI)、CT血管成像(CTA)或彩色多普勒显像检查。结果 56例患者的103条病变肢体共有膝下动脉长段闭塞血管127支,平均闭塞长度(14.51±5.62)cm;其中106支长段闭塞动脉通过球囊扩张成形得以再通,经皮腔内血管成形术成功率为83.5%。术后所有开通成功的患肢皮温改善明显,术后患者的疼痛症状明显缓解或消失。跛行距离、足趾皮温、ABI、TBI等在术后1、3、6、12个月均较术前有显著性改善,P<0.05。共38条肢体(40.9%)发生了再狭窄,12个月的肢体保全率高达92.2%(95/103)。结论经皮腔内血管成形术治疗糖尿病膝下动脉长段闭塞病变,近期疗效确切,安全性较高,虽然其远期再狭窄率较高,但能有效控制病情的发展和缓解临床症状,有助于提高缺血肢体的肢体保全率。

Objective To investigate the value and clinical effect of percutaneous transluminal angioplasty(PTA)in treatment for diabetic patients with long segment obliterans of infrapopliteal artery.Methods 56 diabetic patients with long segment obliterans of infrapopliteal artery were recruited in the present research;the patients included 34 males and 22 females,with an average age 62 years old(ranging 48-76 years old).All the patients were grade based on the Fontaine as follows:levelⅡb in 19 cases with at least middle level intermittent claudication,level Ⅲ in 21 cases with ischemic rest pain,and level Ⅳ in 16 cases with lower limb skin ulcer and/or gangrene.Before treatment,all affected limbs were examined with multislice spiral CT angiography(MSCTA)and digital subtraction angiography(DSA),and inspected claudication distance,toe skin temperature,ankle brachium index(ABI),toe brachial index(TBI).Those were closely observed on a regular basis and followed up 12 months to evaluate the efficacy after operation.The changes of the clinical symptoms were followed up.Those were inspected claudication distance,toe skin temperature,ABI,TBI and MSCTA or color Doppler imaging at 1,3,6 and 12 months after operation.Results 127 arteries in 56 cases were selected for PTA,and a verage occlusion of vessel length were(14.51±5.62)cm.106 arterial branches of 51 cases were recanalized,with a technical success rate of 83.5%.All patients who operated successfully achieved clinical remission included claudication distance,toe skin temperature etc.There exist significant difference at 1,3,6,12 months after the PTA in claudication distance,toe skin temperature,ABI,TBI from that before operation(P<0.05).38 limbs(40.9%)expressed as restenosis.12-month limb salvage rate was 92.2%(95/103).Conclusions PTA is a safe and effective method for diabetic patients with long segment obliterans of infrapopliteal artery,yielding high recent clinical success with a low complication rate.Although its long-term restenosis rate is high,but can effectively control the development of the disease and the clinical symptoms,help to improve the limb salvage rate of ischemic limbs.