外周动脉疾病194例诊治体会

Experiences in the diagnosis and treatment of 194 cases of peripheral arterial disease

目的总结外周动脉疾病(peripheral arterial disease,PAD)的诊治体会。方法分析2007年8月至2011年8月收治的PAD连续病例共194例,手术治疗主要采用血管重建术,包括经皮腔内血管成型(percutanoustransluminal angioplasty,PTA)/支架成型和旁路手术,术后辅以抗血小板等综合治疗。对于术后病变仍继续进展,或广泛感染虽经清创和全身应用抗生素仍无法控制感染并危及生命者,则行截肢术。结果本组病例中181例施行血管重建术,其中136例通过腔内技术(PTA/支架成型)实现。最终截肢共18例,住院期间死亡6例。最终治疗有效率达82%。相比较于非糖尿病患者,合并糖尿病者间歇性跛行发生率较低,而溃疡、坏疽和感染的比率较高。结论血管重建是治疗PAD的基本方法 ,通过明确诊断及适当治疗,多数PAD患者可通过血管重建取得较好的疗效,并且对于多数病例,血管重建可通过腔内技术实现。

Objective To review the experiences in diagnosis and treatment of peripheral arterial disease （PAD）. Methods Clinical data of 194 hospitalized patients with PAD during admitted from August 2007 to August 2011 were retrospectively reviewed. Endovascular revascularization procedures were performed with percutanous transluminal angioplasty （PTA） by ballooning and/or stenting, or open surgical bypass. For patients ineligible for revascularization who had diffuse gangrene and uncontrollable infection after extensive debridement and vigorous antibiotic use amputation was performed as the last measure. Results Revascularization was achieved in 181 cases, with 136 of them by endovascular methods; 18 of all the cases ultimately subjected to amputation and 6 died during the hospitalization. Alleviation of the symptoms was achieved in most of the cases with an overall success rate of 82%. Patients complicated with diabetes had a lower rate of intermittent claudication yet a higher rate of ulcer, gangrene and infection. Conclusion The most fundamental approach in treating PAD is revasculadzation, which can be achieved in most cases by endovascular techniques.