经皮腔内血管成形术治疗糖尿病患者膝下动脉病变

Percutaneous transluminal angioplasty for treatment of below-the-knee arterial lesion in diabetic patients with lower extremity ischemia

目的观察膝下动脉经皮腔内血管成形术在糖尿病性下肢重度缺血的疗效。方法回顾分析首都医科大学附属北京同仁医院血管外科于2007年2月至2011年5月膝下动脉经皮腔内血管成形术治疗2型糖尿病下肢缺血的74例资料,记录其内科情况、Rutherford分期、介入治疗完成时的流出道SVS评分以及术后30d并发症。随访并通过Kaplan-Meier方法计算一期通畅率、症状缓解率、生存率、保肢率,观察其疗效。结果入选患者74例,患肢89条。平均年龄(70.5±7.4)岁。吸烟者30例、高脂血症22例、高血压病36例、冠心病20例、肾功能不全12例。Rutherford分期:Ⅲ期29条、Ⅳ期30条、Ⅴ期16条、Ⅵ期14条。术前踝肱指数(ABI)平均0.37(0～0.72)。术前胫腓动脉流出道评分平均7.5分(3.5～10分)。膝下腔内血管成形术技术成功率92.1%,术后ABI0.78(0.33～1.15)(P<0.01),术后胫腓动脉流出道评分平均6.0分(1.5～10分)(P<0.01)。随访患者74例,平均随访时间12个月(术后1～23个月),失访6例,其中死亡3例均死于急性心肌梗死,随访率91.9%。1年生存率94.6%,1年保肢率91.9%。术后1年一期通畅率52.8%,1年时症状缓解率83.4%。结论膝下动脉经皮腔内血管成形术术后1年的通畅率较低,但症状缓解率明显,有较高的保肢率,使其可以作为糖尿病膝下动脉闭塞治疗的首选,远期疗效还有待进一步观察。

Objective There is documentation of the effectiveness of pereutaneous transluminal angioplasty （PTA） of infrapopliteal artery for the treatment of diabetic patients with lower extremity ischemia. Methods A retrospective database of 74 patients with type 2 diabetes mellitus （ 89 limbs ） undergoing infrapopliteal balloon angioplasty between Feb 2007 and May 2011 was queried. Demographic characteristics and possible related diseases were recorded. Patients were classified according to Rutherford stages. SVS runoff scores were determined after the completion of the intervention and the primary patency ,limb salvage, and target vessels patency assessed by Kaplan- Meier life-table analysis. Results There were 89 PTAs undertaken in 74 patients [ mean age （ 70. 5±7. 4 ） years ], with smoking 30 patients, hyperlipidemia 22 patients, hypertension 36 patients, coronary artery disease 20 patients and renal insufficiency 12 patients. Rutherford stage Ⅲ 29 patients, stage Ⅳ 30 patients, stage V 16 patients and stage VI 14 patients. Technical success was achieved in 82 （ 96% ） limbs. Ankle-braehial index （ABI） improved from 0. 37 （0-0. 72 ）to 0. 78 （0. 33-1.15 ）. The median score of runoff improved from 7. 5 （3.5-10）to 6. 0 （1.5-10）. Sixty eight （91.9%）patients were followed up from 1 month to 23 months （median 12 months）. Three patients were died of acute myocardial infarction during follow-up. The survival rate,limb salvage rate and patency at 1 year were 94. 6%, 91.9% and 52. 8% separately. The symptoms relief rate was 83.4%. Conclusions Our results showed that the patency rate of infrapopliteal PTA was lower, but the limb salvage rate and symptoms relief rate were higher. These data suggested that PTA should be considered as initial therapy for treatment of infrapopliteal artery stenosis or occlusion with type 2 diabetes mellitus. Further research is warranted to evaluate long-term outcome.