复杂下肢动脉硬化闭塞症的腔内治疗效果

Clinical efficacy and outcome of endovascular therapy for complex arteriosclerosis obliterans of the lower extremities

目的 探讨复杂下肢动脉硬化闭塞症腔内治疗的效果.方法 入选阜外心血管病医院2011年12月至2013年1月因泛大西洋协作组织共识Ⅱ（TASCⅡ）C或D型病变、Fontaine分期≥Ⅱb期且踝肱指数＜0.9而行腔内治疗的连续下肢动脉硬化闭塞症患者114例,进行回顾性分析.在术后进行门诊或电话随访,观察腔内治疗的效果.结果 TASCⅡC型39例,TASCⅡD型75例;Fontaine分期Ⅱb期78例,Ⅲ期30例,Ⅳ期6例.共138条肢体行介入治疗,开通病变肢体131条,即刻技术成功率为94.9％.踝肱指数由术前的0.54±0.26增至出院时的0.83 ±0.30（P ＜0.01）.围手术期未发生手术操作相关并发症.术后随访（15.7±8.7）个月,6、12和18个月的累积通畅率分别为75.8％（94/124）、68.7％（68/99）和39.2％（20/51）,肢体均保全.结论 腔内治疗复杂下肢动脉硬化闭塞症安全、有效,可作为外科手术的替代治疗.

Objective To evaluate efficacy and outcome of endovascular therapy for complex arteriosclerosis obliterans of the lower extremities.Methods In this single-center retrospective study,the clinical data of consecutive 114 cases with TASC Ⅱ type C/D lower extremity obstructive disease and clinical stage of Fontaine ≥ Ⅱ] b and ankle brachial index 〈 0.9 underwent endovascular therapy from December 2011 to January 2013 were collected.Telephone or clinic interviews were conducted to investigate the clinical outcomes.Results There were 39 TASC Ⅱ type C patients and 75 TASC Ⅱ type D patients,78 patients were in Fontaine Ⅱ b,30 patients in Fontaine Ⅲ and 6 patients in Fontaine Ⅳ stages.Immediate procedural success rate was 94.9% （131/138）.Ankle brachial index was increased from 0.54 ± 0.26 at baseline to 0.83 ± 0.30 at discharge（P 〈 0.01）.No adverse event was observed during the perioperative period.During （15.7 ± 8.7）months follow-up,cumulative patency rate of 6,12 and 18 months was 75.8% （94/124）,68.7% （68/99） and 39.2% （20/51） respectively and limb salvage rate was 100%.Conclusion Endovascular therapy for complex arteriosclerosis obliterans of the lower extremities is effective and safe.