腔内血管成形术治疗膝下动脉硬化闭塞症的临床研究

The study on percutaneous transluminal angioplasty for the below-the-knee arteriosclerosis obliterans with critical limb ischemia

目的评价腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗膝下动脉闭塞性疾病的临床疗效。方法回顾性分析病变位于膝下(below-the-knee,BTK)合并严重肢体缺血(critical limb Ischemia,CLI)的动脉硬化闭塞症患者行PTA治疗的临床效果;测量患者治疗前后的踝肱指数(ankle branchial index,ABI);分别对技术成功率、保肢率和一期通畅率进行统计学分析;并统计患者术后30天的穿刺部位、介入治疗部位和全身的相关并发症。结果共对24例(41条肢体)成功进行PTA治疗,术前ABI平均值为0.31±0.117,术后14天为0.67±0.08,术后12个月为0.49±0.03;技术成功率为93.2%,保肢率为90.2%;一期通畅率3个月为88.6%,6个月为72.6%,12个月为49.1%。本组患者无围手术期死亡,术后并发症发生率为16.7%。结论 PTA治疗合并严重肢体缺血的膝下动脉硬化闭塞症是可行、安全、有效的。推荐PTA作为首选的治疗方法,但其长期疗效有待进一步观察。

Objective To evaluate the clinical results and the patency of below-the-knee arteries after percutaneous transluminal angioplasty （PTA）. Methods From September 2009, ASO patients who presented CLI and in whom the lesions limited to BTK arteries, were included in this study, and a retrospective study were performeded. ABI were measured before and after treatment. Technical success, limb savage, and primary patency were evaluated. 30 day access site, intervention site, and systemic complications were also evaluated. Limb savage, and primary patency were evaluated using the Kaplan-Meier method and compared with fisher＇s exact test. Results PTA were performed on 24 patients （41 limbs）. In this study, the average ABI before treatment is 0.31±0. 117; the average ABI increased to 0.67±0.08 at 14 day,0.49± 0.03 at 1 year after operation. The primary patency was 88.5% at 3 month, 72.6% at 6 month, 49.1% at 1 year. The limb salvage rate was 90.2%, technical success rate was 93.2%. There were no death during the peri-therapeutic period. The postoperative complication rate was 12. 1%. Conclusion PTA is a feasible, safe, and effective procedure, and it should be recommended as the first choice for all patients with critical limb ischemia and in whom the lesions limited to BTK arteries. But the long term outcome needs to be observed in the future.