下肢动脉闭塞性硬化症的介入治疗

Interventional Therapy of arteriosclerosis obliterans in Lower Extremities

目的探讨膝下动脉成形术治疗严重下肢缺血的安全性和疗效。方法回顾性分析自2007年8月～2008年7月采用膝下动脉成形术治疗16例患者共26条严重缺血患肢的结果。糖尿病下肢动脉闭塞性硬化11例(18条患肢),占69.2%,非糖尿病下肢动脉闭塞性硬化5例(8条患肢),占30.8%。有19条患肢静息痛,7条患肢伴有溃疡或足趾坏疽,踝肱指数(ABI):0.1～0.3有11条患肢,0.31～0.5有15条患肢。结果技术成功率为96%(25/26),15条患肢(15/19)疼痛明显缓解,2条患肢(2/19)疼痛减轻,2条患肢(2/19)疼痛无缓解而分别行膝上和膝下截肢;踝肱指数增加了0.5以上有16条,增加0.31一0.5有7条,增加0.1一0.3有2条。随访4～12个月,平均为8.6个月,坏疽足趾脱落、溃疡愈合的5条患肢(5/7);4条(4/24)复发。ABI平均值为0.70。结论应用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,短期有较好疗效,可减少截肢率;中长期疗效有待进一步观察。

Objective To explore the efficacy and safety of below-knee arterial angioplasty for the treatment of severe limb ischemia .Methods Sixteen patients （twenty-six limbs） with severe ischemia of lower extremities from August 2007 to July 2008 were retrospectively studied. Eleven patients （11/16） suffered from diabetes, five patients （5/16） had not suffered from it. Of these lower extremities, 19 limbs suffered from rest pain, and 7 limbs（7/l 9） suffered from ulcer or toe gangrene. ABI was 0.1-0.3 and 0.31-0.5 in 11 limbs,15 limbs. Results The success rate of operation was 96%（25/26）.Pain relieved in 15 limbs （15/19）, reduced in 2 limbs （2/19）; 2 limbs （2/19） remained pain and underwent upper-knee or below-knee amputation. Increase of AB! was more than 0.5 in 16 limbs, 0.31-0.5 in 7 limbs ,0.1-0.3 in 2 limbs. 16 patients were followed up with an average period of 8.6 months（4-12 months）.Of the 5 limbs （5/7） with ulcer healed and toe lost, pain regained in 4 limbs （4/24）. Average value of ABI was 0.70. Conclusion Below-knee arterial angioplasty with balloon catheter for the treatment of severe limb ischemia has a high success rate. Short-term clinical results are encouraging, amputation rate has been reduced, mid-term and long-term results will be followed up.