糖尿病性膝以下动脉病变血管造影分析

Angiographic study of the infrapopliteal artery disease in diabetic patients

目的研究糖尿病性膝以下动脉病变数字减影血管造影(DSA)影像学的血流分级、病变分型。方法 2型糖尿病患者107例的211条肢体成功行DSA检查。根据小腿动脉主干血流连续性和侧支形成将动脉血流分为0、1、2、3、4级;以Fontaine分级表示患肢缺血性临床症状;根据小腿动脉病变程度和累及血管的不同组合,将患肢病变表现分为A、B、C、D四种类型。结果 208条肢体血流分级与Fontaine分级存在负相关(r=-0.438,P<0.01);Fontaine分级与病变分型基本相吻合,但Ⅱ、Ⅲ两级间差异无统计学意义;按A、B、C、D分型顺序,血流分级有逐渐降低趋势(P<0.01)。结论综合病变类型和血流分级,可以较规范地描述膝以下各动脉主干病变程度和各支动脉病变不同组合,以及血管血流和侧支形成状况。

Objective To investigate the lesion types and the flow grades of the infrapopliteal arterial lesion in diabetic patients based on digital subtraction arteriography （DSA）. Methods 107 diabetic patients （211 limbs） with peripheral arterial disease underwent successful DSA on lower extremities. The flow grades of the infrapopliteal arteries （IPA） were categorized based on the blood perfusion and collateral formation of IPA on radiograph film., grade 0, if no blood fluidity and no collateral formations in all trunks of IPA and pedal arteries; grade 1, if two trunks without blood fluidity, one with uncontinuous blood fluidity, and pedal arteries perfused from collateral circulation; grade 2, if only one with continuous blood fluidity, and collateral circulation formed; grade 3, only two with continuous blood fluidity and collateral formations; grade 4, if continuous blood fluidity in all trunks of IPA and pedal arteries. Clinical manifestation was evaluated with the Fontaine stages. The lesion type of the IPA was classified from A to D： A, if 3 trunks of IPA were not occluded or only one was occluded （≤1/3 of total length） ; B, if one of 3 trunks of IPA was occluded（≥2/3） or two arteries with occlusion （one≤1/3, another ≥2/3, or two ≤1/3） ; C, if only two trunks occluded（≥2/3） , or tibioperoneal trunk（TPT） and anterior tibial artery（ATA , 〈1/3） with occlusion as well as posterior tibial（PTA） and peroneal artery（PA） were not occluded; D, 3 trunks of IPA were occluded（〈1/3） or TPT and ATA （≥2/3） with occlusion as well as PTA or/and PA with occlusion. Results The prevalence of type A, B, C and D was 19. 4%, 30. 3%, 24. 2%, and 26.1% respectively. The grade 0, 1, 2, 3 and 4 of flow categories were 7. 6 %, 33. 6 %, 41.2%, 12. 3 %, and 5. 2% respectively. The type Ⅰ, Ⅱ, Ⅲ, and Ⅳ of Fontaine stages were 4. 8% , 8. 7%, 29. 8%, and 56. 7% respectively. There existed a negative correlation between the flow grades and Fontaine stages （r=-0. 438, P〈0.01） in 208 limbs. Fontaine stages approximately accorded lesion types. There was a downward tendency in flow grades from lesion type A to D （P〈0. 01）. Conclusions The analysis of the combined flow grades and the lesion types of the infrapopliteal arteries might be benefit for choosing the appropriate therapy and assessing the prognosis of diabetic foot and peripheral artery disease.