球囊扩张或(和)支架植入术治疗股浅动脉狭窄或闭塞的中远期疗效

Balloon dilation and/or stent placement for the treatment of occlusive arterial disease of lower limb: observation of its mid-long term results

目的随访球囊扩张成形术（PTA）或（及）支架植入术治疗股浅动脉狭窄或闭塞的中远期疗效。并评价影响疗效的相关因素。方法2007年3月-2009年3月收治56例患者共64支狭窄闭塞股浅动脉。患者合并糖尿病、高血压、高脂血症和吸烟史者分别为84．3％（54／64）、75．0％（48／64）、73．4％（47／64）和45．3％（29／64）。按照泛大西洋协作组织（TASC）分型，A型lO支、B型20支、C型18支、D型16支。在A＋B型组中，行VIA手术21例、PTA及支架植入术9例；C＋D型组中行PTA手术21例、VIA及支架植入术13例。术后给予患者抗凝、抗血小板聚集、控制血压及血糖等治疗，观察治疗随访结果。进行保肢率和疗效的多因素分析。结果实际随访47例（52支患肢），失访9例（12支患肢），随访率83．9％。随访期6～36个月，平均（24±18）个月。术后1、2、3年的一期通畅率：A＋B型组中，行trFA及支架植入术9例分别为87．5％、85．7％、57．1％，PTA手术2l例分别为83．3％、75．0％、46．6％；C＋D型组中，行VIA及支架植入术13例分别为92．3％、80．O％、55．6％，PTA手术2l例分别为61．5％、41．7％、25．0％。术后保肢率为94．7％。术后共有23条患肢出现下肢缺血症状复发（1个月内一3年），其中15支为TASCC＋D组病例，8支为TASCA＋B组病例；而按照手术方式划分，其中14支为PTA手术组病例，9支为PTA及支架植入术组病例。在23例下肢缺血复发的患者中，13例血糖未行规律控制，而在未复发患者中仅10例。结论球囊扩张或（及）支架植入术治疗股浅动脉狭窄闭塞病变可以获得良好的中远期疗效。TASCA＋B型优于TASCC＋D型。是否有效控制血糖和TASC分型可能是影响术后疗效的重要因素。

Objective To investigate the mid- long term effectiveness of percutaneous angioplasty （PTA） and/or stenting in treating superficial femoral artery （SFA） stricture of occlusive diseases, and to evaluate the relevant factors affecting therapeutic effect. Methods During the period from March 2007 to March 2009, 56 patients with SFA occlusive diseases were admitted to the hospital. A total of 64 diseased SFAs were detected. Coexisting diabetic mellitus, hypertension, hyperlipidemia and smoking history was seen in 84.3% （54/64）, 75.0% （48/64）, 73.4% （47/64） and 45.3% （29/64） of patients, respectively. According to TASC classification, type A, B, C and D was determined in 10, 20, 18 and 16 arteries, respectively. Ingroups A and B, 21 PTA procedures and 9 PTA plus stenting procedures were carried out, while in groups C and D 21 PTA procedures and 13 PTA plus stenting procedures were conducted. After the treatment, antiplatelet and antithrombotic therapy was given, and medicationfor controlling the hypertension and blood sugar level was also adopted. All the patients were followed up. The limb salvage rate was analyzed. The multiple factor analysis of the survival and effective rate was performed. Results Forty- seven patients （52 limbs） had following- up results, and 9 patients （ 12 limbs） didn＇t keep in touch with the authors. The follow-up rate was 83.9%. The follow-up period was 6 - 36 months, with a mean of （24± 18） months. The arterial patency rates at one, 2 and 3 years after the treatment for patients （n = 9） receiving PTA plus stenting in groups A and B were 87.5%, 85.7% and 57.1% respectively, while for patients （n = 21 ） receiving PTA along were 83.3%, 75.0% and 46.6% respectively. The arterial patency rates at one, 2 and 3 years after the treatment for patients （n = 13） receiving PTA plus stenting in groups C and D were 92.3%, 80.0% and 55.6% respectively, while for patients （n = 21） receiving PTA along were 61.5%, 41.7% and 25.0% respectively. The limb salvage rate was 94.7%. The recurrence of ischemic symptoms was seen in 23 diseased limbs within one month to 3 years after the treatment. Of the 23 diseased limbs, 15 were in C ＋ D groups and 8 were in A ＋ B groups, and, if divided by the surgical pattern, 14 were in PTA group and 9 were in PTA plus stenting group. Of the 23 patients, 13 had not paid enough attention to the blood sugar level. Conclusion For the treatment of superficial femoral artery occlusive diseases, FFA and/or stenting have excellent mid-long term effectiveness. The therapeutic results of TASC type A and B are much better than those of TASC type C and D. Effective control of blood sugar level and TASC classification type are the main factors affecting the therapeutic resuhs.（J Intervent Radiol, 2012, 21： 810-815）