膝下动脉闭塞腔内治疗与手术治疗效果的临床分析

Analysis to angioplasty and bypass surgery for occlusive Infrapopliteal artery disease

目的:评价膝下动脉闭塞球囊扩张成形术和动脉旁路术的治疗效果。方法:回顾性分析2005年12月至2009年5月北京协和医院收治的膝下动脉闭塞重症下肢缺血病例,全部资料都是前瞻性收集并录入数据库,并将治疗结果进行回顾性分析。根据膝下动脉初次处理手段的不同分为2组:球囊扩张成形术(PTA)组、以膝下动脉为流出道行自体静脉旁路移植术(bypass surgery,BPS)组,比较2组手术及随访结果。结果:PTA组54例(61条肢体),男性37例,女性17例,平均年龄66岁;手术前后踝肱指数(ABI)由(0.43±0.27)增加至(0.86±0.21),随访期间一期通畅率63.8%,二期通畅率74.1%,救肢率88.3%。动脉旁路术组17例(17条肢体),男性12例,女性5例,平均年龄67岁,ABI由(0.21±0.19)增加至(0.73±0.38),手术通畅率60%,救肢率87.5%。2组治疗结果差异无统计学意义。结论:膝下动脉腔内成形术的临床治疗效果不次于膝下动脉旁路手术,可以作为膝下动脉闭塞首选的治疗方法。

Objective：To evaluate the results of PTA and bypass surgery for patient with infrapopliteal occlusive disease.Methods：Retrospective analysis all patients who underwent infrapopliteal angioplasty and bypass surgery to treat critical limb ischemia from December,2005 to May,2009 in Department of Vascular Surgery of Peking Union Medical College Hospital.All procedure-related data were prospectively documented in a database.According to the initial therapeutics of choice,patients were divided into two groups to analyzed：Infrapopliteal percutaneous transluminal angioplasty（PTA） group and bypass surgery group.Results：54 patients（61 limbs） with a mean age of 66 years（37 men,17 women） underwent crural angioplasty,Anklebrachial index（ABI） increased from 〔（0.43 ± 0.27） to（0.86 ± 0.21） pre vs.post-operation〕,the primary patency,second patency,and limb salvage rate were 63.8%,74.1%,and 88.3%,respectively.17 patients（17 limbs）with a mean age of 67 years（12 men,5 women） underwent infrapopliteal saphenous vein bypass surgery,ABI increased from 〔（0.21 ± 0.19） to（0.73 ± 0.38） pre vs.post-operation〕,and the patency,and limb salvage rate were 60%,and 87.5%,respectively.The outcomes between the two groups was no significant difference.Conclusion：PTA is not Inferior to bypass surgery,and it can be considered the primary choice for patient with infrapopliteal occlusive disease.