使用长球囊行膝下血管成形术治疗糖尿病严重下肢缺血的回顾性分析

Infrapopliteal angioplasty with a long over-the-wire balloon for the treatment of severe limb ischemia in diabetic patients:a retrospective analysis

目的回顾性分析使用长球囊经皮腔内血管成形术(PTA)治疗糖尿病严重下肢缺血的安全性和疗效。方法从2007年4月到2008年3月,34例患者(53条下肢,119处血管病变)接受了长球囊膝下血管PTA。回顾性分析血管造影图像,根据病变长度和程度进行分类和分级。平均随访期(7.4±2.6)个月,随访期内每3个月进行1次下肢MRA,并收集相关临床资料。结果 92%患者手术成功。踝肱指数(ankle-brachial index,ABI)和经皮氧分压(transcutaneous oxygen tension,TcPO2)分别从治疗前的(0.50±0.18)和(18.85±12.08)mmHg,提高到治疗后的(0.81±0.12)和(39.85±12.67)mmHg。在随访期末,29例患者取得稳定疗效。5例症状复发,其中3例行第2次PTA。共进行了2例大截肢和4例小截肢术,取得94%的保肢率和59%的通畅率。结论使用长球囊行膝下动脉PTA治疗糖尿病严重下肢缺血安全、可行,取得令人鼓舞的中期效果,需要更深入的研究来评估其长期效果。

Objective To retrospectively evaluate the safety and efficacy of percutaneous transluminal angioplasty（PTA）by using a long over-the-wire（OTW）balloon for the treatment of severe limb ischemia in diabetic patients.Methods During the period from April 2007 to March 2008,infrapopliteal PTA by using a long OTW balloon was performed in 34 patients.The patients,with a mean age of（71.8 ± 7.4）years,had 53 affected limbs with a total of 119 vascular lesions.All patients presented with a chief complaint of limb ischemic symptoms.Angiographic findings were retrospectively analysed and the lesions were categorized according to the length and severity.The mean follow-up period was（7.4 ± 2.6）months.Magnetic resonance angiography（MRA）of the lower limb was conducted every three months during the follow-up period,and the clinical data were collected and analysed.Results Infrapopliteal PTA by using a long OTW balloon was successfully carried out in 92.4% of vascular lesions（110/119）.Ankel-brachial index（ABI）and transcutaneous oxygen tension（TcPO2）were improved from preoperative（0.50 ± 0.18）and（18.85 ± 12.08） mmHg to postoperative（0.81 ± 0.12）and（39.85 ± 12.67） mmHg,respectively.At the end of follow-up,29 patients maintained a stable outcome.Recurrence of symptoms were seen in five patients,and three of them had to receive a second PTA.Although two major amputations and four minor amputations had to be done,94% limb salvage rate and 59% patency rate were obtained.Conclusion Infrapopliteal PTA by using a long OTW balloon for the treatment of severe limb ischemia in diabetic patients.is clinically feasible and safe.Its midterm outcome is satisfactory and encouraging although its long-term effect needs to be evaluated with further study.