分期腔内开通技术治疗严重肢体缺血的初步探讨

Preliminary investigation of treating patients with critical limb ischemia by staged endovascular technology

目的探讨分期腔内开通技术在严重下肢肢体缺血高危患者中的应用效果。方法 2013年9月—2015年3月共计16例严重下肢病变患者(均为髂动脉及远端动脉闭塞,TASC-ⅡD)接受分期腔内动脉成形术,收集患者的临床资料并进行回顾性分析,平均随访时间为7.8个月。结果所有病例技术操作成功。患者静息痛在第一次腔内治疗后消失,无截肢发生,无严重并发症出现。两次治疗过程中,术前、术后踝肱指数(ABI)的差异具有统计学意义(P=0.000)。结论分期开通技术可以有效缓解高危严重肢体缺血患者的静息痛症状及组织坏死,避免了一次开通所引起的缺血再灌注损伤、急性心血管事件等严重并发症的发生,提高了患者的生存质量。

Objective To investigate the application of staged endovascular treatment to high-risk patients with critical limb ischemia（CLI）.Methods From September 2013 to March 2015,a total of 16 patients with CLI（both iliac artery and distal arterial occlusion,TASC-ⅡD） underwent the staged endovascular angioplasty.Clinical data of patients were collected and retrospectively analyzed.The average follow-up period was 7.8months.Results The technical success was achieved for all patients.The rest pain of patients disappeared after the first endovascular treatment with no amputation and serious complications.During two treatments,the difference of the ankle brachial index（ABI） before and after surgery was statistically significant（P = 0.000）.Conclusion The staged endovascular technology can effectively alleviate the symptoms of rest pain and tissue necrosis of high-risk patients with CLI,avoid serious complications such as the ischemia reperfusion injury and acute cardiovascular events caused by unstaged endovascular treatment,and improve the life quality of patients.