股深动脉优势供血治疗TASCD型动脉硬化下肢缺血的疗效分析

Efficacy of profound femoral artery revascularization on TASC type D arteriosclerosis obliterans

目的探讨髂动脉通畅的泛大西洋协作组织共识（TASC）D型动脉硬化下肢缺血的治疗方式，比较股浅动脉支架植入术与股深动脉成形术的疗效。方法回顾性地分析2007年1月至2010年12月北京积水潭医院血管外科收治的32例TASCD型下肢缺血患者临床资料，随机分为股浅动脉治疗组（行股浅动脉球囊扩张＋支架植入术）16例和股深动脉治疗组16例，并进行对照分析。通过对比手术前后踝肱指数（ABI）、手术后3年截肢率及症状改善情况评价两种方法的疗效。结果两组患者术后ABI均明显高于术前（P〈0．05）；且股浅动脉治疗组术后ABI高于股深动脉治疗组（P〈0．05）。两组3年后跛行距离〈200米和行截肢手术患者比较，差异均无统计学意义（P〉0．05）。结论髂动脉通畅的TASCD型动脉硬化下肢缺血患者，无论腔内股浅动脉支架植入术还是股深动脉成形术均可改善患者症状，增加肢体血供；股浅动脉支架植入对患者近期远端肢体血供改善优于股深动脉成形术。

Objective To compare the efficacy of revascularization of profound femoral artery versus superficial femoral artery on TASC type D arteriosclerosis obliterans. Methods Clinical data of 45 cases of TASC type D arteriosclerosis obliterans admitted in our hospital from January 2007 to December 2010 were collected and retrospectively analyzed. Sixteen patients received endovascular balloon dilation combined with stent implantation into superficial femoral artery, and another 16 patients underwent similar revascularization but into profound femoral artery. The efficacy variables including ankle-brachial index （ABI）, amputation rate in 3 years after surgery, and the relief of symptoms were used to evaluate the efficacy of the 2 approaches in the 32 cases. Results Revascularization resulted in significant increases in ABI in the 2 groups （P 〈 0.05）, with the post-operative value of the superficial femoral artery group obviously higher than that of the other group （P 〈 0.05）. There were no significant differences in the numbers of patients having claudication in less than 200 m and undergoing amputation in 3 years after surgery （P 〉 0.05）. Conclusion For the patients with TASC type D arteriosclerosis obliterans but iliac artery patency, revascularization of either superficial or profound femoral arteries is an effective treatment to relieve symptoms and enhance blood flow of the ischemic limb. Stent implantation into the superficial femoral artery is more superior in short-term blood supply for distal limb.