高龄患者股腘动脉硬化闭塞症的腔内治疗

Endovascular treatment of femoropopliteal arteriosclerosis obliterans in elderly patients

目的探讨高龄患者股腘动脉硬化闭塞症腔内治疗的技术特点和临床效果。方法回顾性分析2009年3月—2011年1月采用经皮腔内血管成形术(PTA)结合支架植入术进行腔内治疗高龄股腘动脉硬化闭塞症患者50例(62条肢体)的临床资料,其中男30例(38条肢体),女20例(24条肢体);年龄70～88(平均78.5)岁,病程3个月至5年,病变位于股腘及膝下动脉。结果治疗成功58条肢体,技术成功率为93.5%(58/62)。围手术期并发症5例,占8.06%(5/62),其中穿刺处假性动脉瘤形成1例,动脉穿孔1例,动脉夹层2例,心衰1例。根据情况予以处理后均缓解,围手术期无死亡病例。术后第1周踝/肱指数(ABI)由术前的0.58±0.22增至0.88±0.25(t=7.09,P<0.001),术后12个月和24个月肢体一期通畅率分别为80.0%(32/40)和68.8%(22/32),二期通畅率分别为85.0%(34/40)和75.0%(24/32),术后24个月肢体保全率为93.8%(30/32),2例因糖尿病足伴足趾坏死,行保留足跟截趾术。结论腔内治疗高龄股腘动脉硬化闭塞症患者近期效果好,技术成功率高,并发症少,注意围手术期管理能够减少并发症发生,远期疗效还要继续随访观察。

Objective To investigate the technical features and clinical efficacy of endovascular treatment of femoropopliteal arteriosclerosis obliterans in elderly patients.Methods The clinical data of 50 elderly patients（62 limbs） with femoropopliteal arteriosclerosis obliterans undergoing endovascular treatment using percutaneous transluminal angioplasty（PTA） and stent implantation from March 2009 to January 2011 in our hospital were retrospectively analyzed.There were 30 male patients（38 limbs） and 20 female patients（24 limbs）,whose ages ranged from 70 to 88 years（average of 78.5 years）,and whose disease durations ranged from three months to five years.The lesions were located at femoropopliteal and infrapopliteal arteries.Results Fifty-eight limbs were successfully treated and the technical success rate was 93.5%（58/62）.Perioperative complications occurred in five patients that accounted for 8.06%（5/62）,including one case of pseudoaneurysm formation at the puncture site,one case of artery perforation,two cases of artery dissection and one case of heart failure,which were all resolved after treatment.No perioperative deaths occurred.The ankle-brachial index（ABI） increased from 0.58±0.22 before surgery to 0.88±0.25 one week after surgery（t=7.09,P0.001）.The primary patency rate was 80%（32/40） and 68.8%（22/32）,and the secondary patency rate was 95.0%（34/40） and 75.0%（24/32） at 12 and 24 months after surgery,respectively.The limb salvage rate was 93.8%（30/32） at 24 months after surgery.Two patients underwent metatarsal-phalangeal amputation due to diabetic foot with necrotic toe.Conclusions For the elderly patients with femoropopliteal arteriosclerosis obliterans,the endovascular treatment has better short-term effect,high technical success rate and low complication incidence.Rigorous perioperative management can prevent the occurrence of complications,and its long-term efficacy needs to be assessed by further follow-up.