膝下动脉球囊血管成形术治疗重症下肢缺血的临床研究

A clinical study of infrapopliteal balloon angioplasty for patients with critical lower limb ischemia

目的评价膝下动脉闭塞首选球囊血管成形术的临床治疗效果。方法2005年12月至2009年5月，对于连续收治且符合手术指征的54例（61条肢体）膝下动脉重度狭窄或闭塞的重症下肢缺血患者，采用膝下动脉球囊血管成形术进行治疗。其中男性37例，女性17例，平均年龄66岁。术前踝肱指数平均0．43±0．27。根据病变部位选择手术方法，膝下动脉病变首选球囊血管成形术，合并髂股动脉病变同时进行血管重建（支架置入或动脉旁路术）。结果髂股动脉重建（28条肢体行支架置入，5条肢体行动脉旁路术）均一期成功。膝下动脉球囊血管成形术57条肢体获得一期成功，技术成功率93．4％。围手术期主要并发症为小腿血肿3例（4．9％），膝下截肢2例（3．3％）。术后踝肱指数增加至0．86±0．21，与术前相比差异有统计学意义（P〈0．01）。本组平均随访时间（16±11）个月，一期通畅率61．1％，21条肢体发生再狭窄（38．9％），其中10条肢体再次接受外科干预，二期通畅率75．9％。截肢3条肢体，总的救肢率91．8％。结论球囊血管成形术是治疗重症下肢缺血安全有效的方法，可以作为膝下动脉病变首选的外科干预手段。

Objective To evaluate the efficacy of infrapopliteal angioplasty as the first-choice procedure in patients with critical lower limb ischemia. Methods From December 2005 to May 2009, infrapopliteal angioplasty was considered as the first-choice method in consecutive patients with infrapopliteal occlusive disease hospitalized for critical ischemia. Fifty-four patients （61 limbs ） with a mean age of 66 years old （37 male and 17 female） underwent infrapopliteal balloon angioplasty. The preoperative ankle branchial index （ABI） was 0. 43 ±0. 27. Results Iliofemoral artery revascularization （stenting in 28 limbs and bypass in 5 limbs ） were successful. Infrapopliteal balloon dilation was success in 57 limbs, the technical success rate was 93.4%. The major complications were calf hematoma in 3 cases （4. 9% ） , and below-the-knee amputation in 2 cases （3. 3% ）. Postoperative ABI increased to 0. 86 ± 0. 21 （P 〈 0. 01 ）. Mean follow-up time was （ 16 ± 11 ） months. The primary patency rate was 61.1% , restenosis rate was 38.9% （21 of 54 limbs）, and surgical intervention were performed for 10 limbs, the secondary patency rates was 75, 9%. Major amputation in 3 limbs during follow-up period, the limb salvage rate was 91.8%. Conclusion Infrapopliteal balloon angioplasty as the first-choice method is feasible, safe and effective for limb salvage in patients with critical lower limb ischemia.