经皮腔内血管成形术联合动脉内药物灌注治疗糖尿病性下肢重症缺血

Percutaneous transluminal angioplasty combining intra-arterial drug infusion for the treatment of diabetic critical lower limb ischaemia

目的:探讨经留置导管持续动脉内抗凝溶栓联合PTA治疗糖尿病下肢严重缺血的临床价值。方法:回顾性分析21例糖尿病性下肢重症缺血患者的临床资料。根据受累血管的数目及程度考虑PTA前是否接受溶栓治疗,再对溶栓组15肢和未溶栓组13肢的PTA结果进行统计学分析。随访6～36个月,并做好随访记录。结果:21例28侧肢体膝下动脉受累77支,狭窄性病变32支(41.6%),完全闭塞性病变45支(58.4%)。溶栓组和未溶栓组,对于狭窄性病变的技术成功率分别为92.3%(12/13)、88.9%(16/18);对于闭塞性病变的技术成功率分别为75.9%(22/29)、31.2%(5/16),差异具有统计学意义。术中并发症5例,主要为小斑块脱落、血管痉挛及夹层等,未出现与手术相关的严重并发症。随访时间6～36个月。随访期间4例复发,复发率19.0%,3例接受二次介入治疗。结论:对于糖尿病性下肢严重缺血性病变,经留置导管动脉内长时间持续溶栓联合PTA对于闭塞性病变具有较高的成功率,近期疗效确切,具有很好的扩大应用潜力。

Objectlve：To study clinical value of inn＇a-arterial catheter thromholytic anticoagulant continuously combining percutaneous transluminal angioplasty （PTA） in the treatment of the isehemia lower limbs in the diabetic. Methods： Retrospective analysis the clinical data of 21 cases lower limb serious ischemia in the diabetic. According to the extent of the lesions, it can be divided into stenosis and occlusive diseases, according to the number and the extent of involved vesse, we consider ff all cases accept the treatment of thrombelysis. Then according to the results Of PTA （15 limbs treated by thrombolysis and 13 limbs not treated by thrombolysis）, the statistical analysis was conducted. Regular follow-up examinations should continue for 6 - 36 months. We record the results according of regular foUow-up examination.Results：Them were 21 cases include 28 lateral limbs. Below-knee artery were involved more than 7 branches. 28 branches were narrow lesions and 45 branches were totally occluded. In the group of thrombolysis, the success rates of stenotic lesions was 92.3% （12/13）, and that of occlusive diseases was 75.9% （22/29）. In the group of no thrombolysis, the success rates of stenotic lesionss was 88.9%（16/18）, and that of occlusive diseases was 31.2% （5/16）. Statistical differences among those was significant. 5 patients appeared intraoperative complications. The mainly intraoperative complications included small plaque off, vasospasm and dissection etc. Them were not the serious complications associated with surgery. All the limb isehemic symptoms were significantly reduced or disappear after interventional treatment. Regular follow-up examination should continue for 6 36 months. 4 cases appeared recurrence during the follow-up. Relapse rate was 19.0%, 3 cases underwent a further PTA. Conclusion：For the diabetic isehemic lower limb disease, by intraarterial catheter prolonged thrombolytic united PTA for occlusive disease have a high success rate, the short-term efficacy was precise. There were good potential to expand the application.