介入再通血管技术在下肢动脉闭塞性病变中的应用

To evaluate the effect and clinical outcome of interventional therapy for lower limb ischemia

目的：探讨介入治疗下肢动脉闭塞性疾病的中长期疗效。方法：选择下肢动脉闭塞性疾病患者260例,均经血管彩超及64排CT血管造影（CTA）确诊。其中髂动脉病变65条患肢,股腘动脉病变202条患肢,股腘动脉病变累及膝下三分支58条患肢,膝下小腿动脉分支闭塞43条患肢,每例患者均先球囊扩张治疗,如扩张不满意或出现夹层等酌情支架置入,术后随访12~72个月,分析介入治疗后的中长期疗效。结果：术中未出现血管破裂、穿孔等严重并发症;患者术后踝肱指数（ABI）较术前有明显升高,下肢动脉闭塞相关症状明显改善。随访期间患者再次出现下肢缺血症状142例,经数字减影血管造影（DSA）检查,内膜增生引起支架阻塞80例,非治疗部位血管出现狭窄或闭塞病变而出现下肢缺血症状30例,另外经皮血管成形术（PTA）治疗部位血管再狭窄12例,均经再次介入治疗后缺血症状改善。另有115例多次彩超复查示管腔通畅、血流良好;3例患者于术后16个月内死于脑卒中或心肌梗死。结论：介入治疗下肢动脉缺血性疾病操作创伤小,中长期疗效好,具有良好的临床应用价值。

Objective：To evaluate the effect and clinical outcome of interventional therapy for lower limb ischemia. Methods：Data of 260 patients with lower limb ischemia confirmed by vascular ultrasoundand and 64- slice spiral computed tomography angiography（ CTA）. Among all patients,65 limbs were iliac arterial occlusion,and 202 case were iliac and femoral arterial,58 cases were femoral- popliteral and infra- popliteral artery,43 cases were infra- popliteral artery. All arteries underwent percutaneous transluminal angioplasty（ PTA） and selected stent implantation fellowed in cases of dissection or residual stenosis after balloon angioplasty（179 patients,203 stents）. All patients were followed up for 12 ~ 72 months. The middle and long- term efficacy after interventional therapy was analyzed. Results：NO severe complications such as angiorrhexis and perforation were found during the interventional therapy. The symptoms of lower limb ischemia of all patients after interventional therapy were alleviated or disapp- eared. During the follow- up,3 patients died of acute myocardial infarction or strike at 16 months after interventional the- rapy,and 142 patients had the symptoms of lower limb ischemia again. DSA showed that stent occlusion caused by intimal hyperplasia occurred in 80 cases,and lower limb ischemia caused by vascular lesions at the site of non- therapy occurred in 30 cases,and the restenosis at the site of th- rombolysis and PTA therapy were 9 cases. These patients got better and discharged from the hospital after PTA or stent implantation therapy. The other 115 cases had no recurrence. The result of vascular ultrasound re- examinaxion showed smooth lumens and good blood flow. Conclusion：Int erventional therapy for lower limb ischemia has minimal invasion and good middle and long- term efficacy,so it has value of clinical application.