下肢动脉硬化闭塞疾病血管腔内治疗

Endovascular treatment of arteriosclerosis occlusive disease of lower extremities

目的评价经皮血管腔内球囊扩张(PTA)和支架置入(PTAS),治疗下肢动脉硬化闭塞症(LEAOD)的临床效果和应用价值。方法1995年5月至2009年1月,169例下肢动脉硬化闭塞症接受了经皮血管腔内PTA和PTAS。结果全组治疗成功率97.63%(149/169),除4例LEAOD患者支架置入失败外,其余病例均治疗成功,临床症状消失或好转,踝/肱指数(ABI)由0.1～0.59,平均(0.37±0.19)上升为0.69～1.16(平均0.88±0.17),两者比较差异有统计学意义(P<0.05)。术后随访3～60个月,仅统计6、12、36、60个月的通畅率,68例髂动脉为:98.53%、92.65%、91.18%、89.71%;60例股浅动脉中、上2/3段阻塞为:91.67%、86.67%、81.67%、73.33%;41例股浅动脉下1/3段阻塞为:85.37%、78.05%、68.29%、56.09%。结论经皮血管腔内PTA和PTAS治疗LEAOD,可使闭塞血管得到长期的有效开通,显著提高血流动力学指标,是安全有效的治疗方法。

Objective To study the clinical effect and applied value of pecutaneous transtuminl angioplasty（PTA） and pecutaneous transtuminl angioplasty and stenting（PTAS） on lower extremity atherosclerotic occlusive disease（LEAOD）. Methods From May 1995 to January 2009, pecutaneous transtuminl angioplasty and stenting treatment was performed in 169arteriosclerosis obliterans LEAOD patients. Results Total achievement ratio was 97.63% （149/169）.Except the PTAS treatment for 4 LEAOD patients was failed,the others were doing well for clinical symptom disappear or better, whose average ankle brachial index（ABI） were 0.11-0.58（0.37±0.19） and 0.69-1.16 （0.88±0.17） respectively. The statistical result showed a significant difference in ABI （P〈0.05）. follow-up visiting for 3-60 months; The encumbered superficial femoral artery （63 patients in Arteria iliaca, 55 patients in middle-upper 2/3 segment of superficial femoral artery and 35 patients in meta-infer 1/3 segment） keep smooth bloodstream with a proportion of 98.53%, 92.65%, 91.18%, 89.71%; 91.67%, 86.67%, 81.67%, 73.33%; 85.37%, 78.05%, 68.29%, 56.09% respectively, the time of follow-up visit was 6, 12, 36 and 60 months. Conclusion The PTA and PTAS treatment for LEAOD was a safe and effective option. ,which could make obstructed blood vessel long-term enlighten in effect and remarkably raise the haemodynamics index.