下肢慢性缺血性疾病腔内介入治疗的临床研究

Clinical research of endovascular therapy to chronic lower limbs ischemic diseases

目的探讨下肢慢性缺血性疾病(动脉硬化闭塞症、糖尿病足、血栓闭塞性脉管炎等)血管腔内介入治疗的方法、疗效及预后。方法回顾性分析我科自2009年10月以来应用血管腔内介入技术治疗的60例下肢慢性缺血性疾病的临床资料。治疗方式主要包括球囊扩张(PTA)或球囊扩张+支架植入(Stent)。手术操作在介入室进行,狭窄为主的病例以球囊扩张为主,若扩张后有夹层形成或不能维持扩张效果的,则植入支架。结果 60例患者中,支架植入34例(均采用自膨式支架),21例行单纯球囊扩张成形术(PTA),5例因导丝导管无法通过病变段管腔而放弃治疗。总成功率为92%。无手术死亡病例。围手术期无心脑血管意外、血管破例大出血等严重并发症发生。治疗成功病例中,8例患者术前未触及股动脉搏动而术后可触及,13例患者术前未触及腘动脉搏动而术后可触及,7例患者术前未触及胫后或足背动脉搏动而术后可触及,另有23例患者术后踝/肱指数(ABI)明显增加,9例患者(包括手术失败的5例)术后血运无明显改善,有效率为85%。结论血管腔内介入方法治疗下肢慢性缺血性疾病是一种新兴、有效和安全的方法,它可与以往传统的血管外科治疗手段优势互补,遵循安全简单有效的原则,降低了手术的难度和复杂性,减少了并发症,并为一些治疗困难,不能耐受手术的高危患者提供了治疗的机会。

Objective To study the methods, efficacy, prognosis of endovascular therapy in the treatment of the chronic lower limbs ischemic diseases, such as atheroseterosis block disease, diabetes foot and thromboangiitis ob- literans. Methods The clinical data of 60 patients of chronic lower limbs of ischemic diseases treated with endovas- cular therapy from October 2009 was retrospectively analyzed. Treatments mainly included PTA balloon dilation or ex- pansion balloon expansion combined with stents. All surgical procedures were performed in the Radiation Intervention Room. For patients mainly with narrow, PTA balloon dilation is given priority to, for those with interlayer after expan- sion, stent is performed. Results Of the 60 patients, 34 underwent stent, 21 underwent PTA balloon dilation, 5 give up treatment due to the filar guide catheter can not get through the lumen. The total success rate was 92%, and no pa- tients died during operation. In the perioperative period, no severe complications were found, such as cerebrovascular accidents, hemorrhage. Among the successful cases, in 8 patients, the femoral arterial pulses could not reach preopera- tively and became palpable postoperatively. In 13 patients, the popliteal pulses could not reach preoperatively and be- came palpable postoperatively. In 7 patients, the posterior tibial or foot back pulses could not reach preoperatively and became palpable postoperatively. 23 patients had the ankle/humerus （ABI） indexes significantly increased preoperatively, and 9 patients （including 5 failed cases） had no obvious improvement in postoperative blood supply. The total effective rate was 85%. Conclusion Endovascular therapy is a new, effective and safe method for treating chronic lower limbs in ischemic diseases, which follows reduces the complexity and difficulty of the operation, lowers the incidence of complications, and provides treatment for high risk patients can not tolerate the surgery.