膝以下动脉硬化闭塞症的介入治疗

Treatment and Research of Arteriosclerosis Obliterians for Infrapopliteal Arteries

目的：探讨膝以下动脉硬化闭塞症腔内治疗的方法、难点、并发症处理以及预后。方法：2008年1月至2011年12月，采用介入方法治疗膝以下动脉硬化闭塞症72例（84条肢体）。采取股总动脉顺行或逆行穿刺，下肢动脉造影，以导丝配合导管通过动脉狭窄段，或开通动脉闭塞段；开通失败者，尝试内膜下血管成形术；经导丝引入球囊进行扩张，扩张完毕后造影，如残余狭窄＞30％，则再次扩张；出现动脉夹层者，行药物洗脱支架植入。结果：84条肢体行介入治疗，82条肢体获得影像学成功，技术成功率为97．6％。术后16例间歇性跛行患者跛行距离平均增加500 m（50～2500 m），43例静息痛者疼痛均减轻或消失，8例足趾溃疡者经换药3个月内溃疡全部愈合，1例足趾溃疡患者因介入术后支架内血栓形成而行股-腘动脉自体大隐静脉原位转流术。3例足趾坏疽者行截趾术，术后3个月内创口愈合。1例前半足坏疽者行膝下截肢。术后6个月、1年肢体通畅率分别为96．3％和95．0％，术后1年肢体保全率为95．0％。结论：对于膝以下动脉狭窄或闭塞性病变者行腔内治疗，成功率高、效果明显、并发症少、保肢率高、可重复治疗，是安全有效的治疗方法。

Objective：To investigate the approaches , nodi, therapies of complications and prognosis of endovascular treatment for patients with infrapopliteal arteries arteriosclerosis obliterians （ ASO） .Methods：We conducted endovascular treatment for 72 patients （ 84 limbs ） between January 2008 and December 2012 and punctured femoral artery antegrade or retrograde , made lower extremity artery angiography , then used guide wire and catheter getting through the artery stenosis or occlusion .If failed, subintimal angioplasty was tried .Balloon was introduced with guiding wire to dilatating the vascular .After expansion , artery angiography was made to e-valuate if there existed residual stenosis , when residual stenosis was greater than 30%, tried again .If arterial dissection occurred , drug-coated stent was implanted .Results：84 limbs underwent endovascular treatment and 82 achieved angiographic success with 97.6%clinical success rate .16 cases with intermittent claudication in-creased claudicating distance of 500 m （50-2 500 m）, resting pain of 43 cases lightened or disappeared , toe ulcer of 8 cases healed with dressing change after 3 months, 1 toe ulcer case autologous saphenous vein bypass because of in-stent thrombosis.3 cases with toe gangrene took operations and the wound healed in 3 months.1 case with anterior half foot gangrene took below -knee amputation .Conclusions：Endovascular treatment is a safe and effective method for infrapopliteal arteries ASO , and which can be repeated , achieve a high clinical success rate with a low complication rate and a high limb salvage rate .