介入疗法治疗糖尿病足患者膝以下动脉病变

Clinical value of interventional therapy for below-knee arterial disease in diabetic foot

目的探讨糖尿病足患者膝以下动脉的血管病变特点及血管介入治疗的方法和临床价值。方法用Seldinger技术,经股动脉顺行或逆行穿刺插管,对36例患者43条患肢行对比剂跟踪数字减影血管造影(DSA),然后对膝以下病变动脉行球囊成型术。结果糖尿病足血管病变范围广,膝以下血管以重度乃至完全闭塞为主,同时累及双支及三支血管者38条,约占88.37%;43条患肢膝以下血管介入总成功率88.37%;所有手术成功患肢血流均明显改善,疼痛、麻木感缓解,皮温及ABI指数明显升高,溃疡愈合加快。结论经皮血管球囊成型术微创、安全、有效,对糖尿病足膝以下动脉介入治疗近期疗效满意,可明显改善患肢血供。

Objective To evaluate the characteristic of below-knee arteries in patients with diabetic foot, and to assess the efficacy of angioplasty in the treatment of diabetic foot. Methods After anterograde or retrograde percutaneous puncture of femoral arteries, thirty-six diabetic patients （forty-three lower extremities） with foot ulcers were examined with digital sub- traction angiography （DSA）, then the stenosis of below-knee arteries were treated by percutaneous transluminal angioplasty （PTA）. Results The lesion of lower extremity in diabetic foot ulcers were extensive, most of them had severe stenosis, even complete occlusion. The incident rate of stenosis was 88.37%, including double and triple vessel involvement. The successful rate of PTA in 43 cases was 88.37 %. PTA was effective in promotion of the lower extremity arterial blood perfusion and remission of the pain and numbness. After therapy, the skin temperature and the ankle brachial index were promoted, and the ulcers were found heal faster than before. Conclusion PTA is a safe and effective method for treatment of the stenosis of below-knee arteries, and is effective in promotion of the lower extremity arterial blood perfusion.