膝下动脉闭塞的腔内治疗

Endovascular intervention for infrapopliteal arterial occlusion

目的总结40例膝下动脉闭塞腔内治疗的疗效。方法2006年11月至2007年12月期间40例下肢膝下动脉闭塞患者41条患肢行44次腔内治疗，平均年龄（76±6）岁，治疗前踝／肱指数（ankle braehial index，ABI）足背动脉0．39±0．20，胫后动脉0．39±0．23，严重下肢缺血（critical limb ischemia，CLI）占80．49％（33／41）。结果治疗后ABI足背动脉提高了0．43±0．22（P〈0．01），胫后动脉提高了0．43±0．25（P〈0．01）。35例36条肢体获随访，平均随访（6±3）个月，Fontaine I级与Fontaine II A级肢体共计28条，占77．78％，CLI降至19．44％（7／36），显著低于治疗前（P〈0．01），随访时ABI足背动脉0．63±0．22，胫后动脉0．56±0．22，与治疗前相比差异均有统计学意义。治疗后及随访时患肢的足背动脉与胫后动脉ABI比较差异无统计学意义。全组围手术期截肢率为0，围手术期死亡率2．5％，总死亡率15％，保肢率100％。结论膝下动脉腔内治疗后疗效和平均随访6个月的疗效均令人满意；膝下动脉腔内治疗可以成为膝下动脉闭塞治疗的首选方法。

Objective To evaluate the results of endovascular intervention for infrapopliteal arterial occlusion in 40 patients. Methods There were 41 affected limbs in these 40 patients receiving 44 times of endovascular intervention for infrapopliteal arterial occlusion during Nov. 2006 and Dec. 2007. The average age was 76 ±6. The ABI（ ankle brachial index）before intervention was 0. 39 ±0. 20 in anterior tibial artery and 0. 39 ± 0. 23 in posterior tibial artery. CLI （ critical limb ischemia ） was 80. 49% （ 33/41 ）. Results The after intervention ABI increased by 0. 43 ± 0. 22 （ P 〈 0. 01 ） in anterior tibial artery and 0. 43 ± 0. 25 （ P 〈 0. 01 ） in posterior tibial artery. 35 patients （ 36 limbs） were followed-up for （ 6 ± 3 ） months. The limbs of Fontaine I and Fontaine II A were 28 （ 77. 78% ）, CLI decreased to 19. 44% （ 7/36 ） （P 〈0.01）. At follow-up the ABI in anterior tibial artery was 0. 63 ±0. 22 and 0. 56 ± 0. 22 in posterior tibial artery, The difference were all significant when compared with that before intervention and after intervention. The perioperative amputation rate was 0. The perioperative mortality rate was 2. 5%. The total mortality rate was 15%. The limb salvage rate were 100%. Conclusion The effect of endovascular intervention for infrapopliteal arterial occlusion is satisfactory.