动脉粥样硬化所致下肢动脉狭窄或闭塞患者的血管腔内治疗及疗效观察

Endovascular interventional treatment and its efficacy for 36 cases of lower limb artery stenosis or occlusion due to atherosclerosis

目的探讨动脉粥样硬化所致下肢动脉狭窄或闭塞血管腔内治疗的临床可行性及应用价值。方法 2009年1月至2013年12月我科收治经CT血管造影（CTA）和数字减影血管造影（DSA）证实为动脉粥样硬化性下肢动脉狭窄或闭塞患者36例（42条患肢）,将行经皮腔内球囊扩张血管成形术（PTA）或/和支架植入术治疗。按照Fontaine分型治疗后临床症状改善1级或1级以上为临床成功,PTA后血管残余狭窄小于30%为技术成功。通过术后临床症状改善和CTA/MRA随访来评价治疗效果。结果 PTA技术成功率为95.2%（40/42）,1条技术不成功,1例术后合并动脉血栓,无血管夹层形成。39条肢体症状改善明显,2条无明显改善,踝肱指数从（0.50±0.11）至（0.82±0.15）。术后随访6个月Fontaine分型提高1、2、3级的患者分别为23例、13例和4例（40条患肢）。随访3~15个月,1条股动脉在12个月再次闭塞,1条胫后动脉术后8月再次闭塞,通畅率为92.8%。结论动脉粥样硬化所致下肢动脉狭窄或闭塞腔内介入治疗是安全,有效的,其有助于改善下肢血运,提高通畅率,改善患者生存质量,提高中长期保肢率。

Objective To assess the clinical value of endovascular interventional treatment for lower limb artery stenosis or occlusion due to atherosclerosis. Methods Thirty-six lower limb artery stenosis or occlusion cases（42limbs） proved by CTA/DSA between Jan. 2009 and Dec. 2013 from the hospital were collected and given treatment of percutaneous transluminal angioplasty（PTA） or/and stent implantation. According to Fontaine classification, clinical success was identified when patients clinical symptoms were improved by one or more grade, and residual stenosis 〈30%were defined as technical success. The treatment＇ efficacy was evaluated through the improvement of clinical symptoms and manifestation of CTA/MRA follow-up. Results The PTA technical success rate was 95.2%（40/42）, with one failed and one with postoperative combined arterial thrombosis and no dissection. Clinical symptoms were improved significantly in 39 limbs while not obvious in 2 limbs, ankle-brachial index（ABI） increased from（0.50±0.11） to（0.82±0.15）.After 6 months of follow-up, there were respectively 23, 13, and 4 cases（40 limbs） of Fontaine grade 1, 2 and 3 improvements. After 3~15 months of follow-up, there were one femoral artery occlusion at the 12^th month and one posterior tibial artery reocclusion at the postoperative 8th month, the total patency rate was 92.8%. Conclusion Endovascular interventional treatment is safe and effective for lower limb artery stenosis or occlusion. The treatment could improve lower limb blood supply, patency rate, life quality, and the long-term rate of limb salvage.