血管腔内修复术治疗糖尿病性下肢动脉硬化闭塞症

Extensive use of peripheral particularly in the treatment of diabetes infrapopliteal arteriosclerostic obliteration

目的探讨糖尿病性下肢动脉硬化闭塞症（DASO）的有效治疗方法及疗效。方法采用球囊行血管腔内修复术及持续血管腔内给药治疗DASO135例。结果135例全部实施经皮腔内血管成形术（PTA）治疗成功,48例术后保留导管持续给药治疗1周~2周。在胫前动脉、胫后动脉同时狭窄的93条肢体病变中均开通者59例,其他34条肢体胫前动脉或胫后动脉只开通1支血管,其中2条肢体胫前动脉和1条肢体胫后动脉未能通过导丝（行成夹层）。所有病例均未放置支架。术后48例患肢动脉内留置硬膜外导管持续治疗。135例患者临床症状均得到改善。在足趾坏死6例中,2例足趾末端脱落愈合,4例截肢后一期愈合。无围术期死亡及严重并发症发生。PTA之后,踝肱指数（ABI）及经皮氧分压（TcPO2）获得明显的改善（P〈0.001）。随访6~36个月,累积首次通畅率分别为81%、70%、59%、51%,累积二次通畅率分别为90%、83%、78%、71%,其中有36例再狭窄或闭塞,再行球囊扩张及支架植入治疗,疗效满意。结论PTA治疗糖尿病性下肢动脉硬化闭塞症疗法肯定,且可重复应用。最大限度地降低踝上截肢率。对于罹患足溃疡及周边动脉阻塞性疾病（PAOD）的糖尿病病人,PTA应作为血管再通的首选治疗方法。

Objective Exploring the effective treatment and therapeutic effect of infrapopliteal arteriosclerotic obliteration（hereinafter referred to as DASO）of diabetes infrapopliteal arteriosclerotic obliteration.Methods Sac-culo vascular prosthesis and continuous intravascular medicine transfusion were used in the treatment of 135 cases with DASO.Results 135 cases treated with PTA were great successes,among which 48 after operation were kept on giving intravascular medical transfusion for one to two weeks.59 extremities went through of 93 cases with both anterior tibial artery and arteria tibial posteror.And 1 blood vessel was deoppilated in the rest 34 with anterior tibial artery or arteria tibial posterior,among which there were 2 with anterior tibial artery and 1 with arteria tibial posterior can not get through guidewire（dissection formed）.No frame was implanted into any of the cases.After operation 48 extremities were kept treating with continuons exyradural duct.Clinical sympotom of 135 cases was improved greatly.Out of 6 cases with toe necrosis,2 were healed after toe terminal exuviations.And after amputa-tion 4 were healed at the primary stage.No death and no serious complication appeared during the perioperation.After PTA,ABI and Tcpo2 improved greatly（P0.001）.Mean follow-up 6 to 36 months,the primary patency was 81%,70%,59% and 51% respectively,the accumulated（total） secondary patency was 90%,83%,78% and 71% respectively.There were 36 cases of restenosis or occlusion,in which balloon dilatation and stent implanta-tion were used,there were satisfactory results about the treatment.Conclusion It is effective and practicable to treat diabetes infrapopliteal arteriosclerotic obliteration with PTA and which can be repeated.It maximumly lowers the rate of supramalleolar amputation.For patients with pathopoiesis foot exulceration and PAOD,PTA should be used as the first selected treatment method in revascu-larization.