膝下动脉硬化性闭塞症的血管腔内治疗诊治分析

Analysis of endovascular treatment for infrapopliteal artery occlusive disease

目的评估经皮血管腔内血管成形术(PTA)治疗膝下动脉硬化性闭塞症的临床治疗效果。方法回顾性收集2012年4月至2013年11月本院78例(103条患肢)住院患者的临床资料,并分析PTA后的踝肱指数(ABI)、术后并发症及一期通畅率的情况。结果经PTA治疗后,患者出院前的ABI(0.83±0.13)较术前(0.35±0.12)明显好转,术后随访3、6、12及24个月,其ABI分别为0.78±0.15、0.72±0.13、0.63±0.14及0.51±0.19;术后3、6、12及24个月一期通畅率分别为93.6%、87.3%、81.2%及73.0%;糖尿病与非糖尿病患者相比,术后3、6、12及24个月一期通畅率分别为92.8%vs 93.9%、83.3%vs 89.5%、72.7%vs 83.9%及59.3%vs 74.1%(P<0.05)。结论血管腔内治疗短期内可以明显改善患肢的血流灌注,挽救肢体,改善患者的生活质量,但其远期的临床疗效有待进一步观察。

Objective To evaluate the clinical effect of percutaneous transluminal angioplasty（PTA） in the treatment of patients with infrapopliteal artery occlusive disease. Methods The data of 78cases（103 limbs） from April 2012 to November 2013 were analyzed retrospectively. The items of ankle brachial index（ABI） after PTA, postoperative complications and primary patency rate were reviewed.Results Compared with preoperative ABI（0.35±0.12）, the ABI after PTA（0.83±0.13） was significantly improved. During the follow-up time, ABI at 3-, 6-, 12-and 24-month was 0.78 ±0.15, 0.72 ±0.13,0.63±0.14 and 0.51±0.19, respectively, and primary patency rate was 93.6%, 87.3%, 81.2% and 73.0%,respectively. Compared with non diabetic patients, primary patency rate of the diabetic patients was 92.8%vs 93.9%, 83.3% vs 89.5%, 72.7% vs 83.9% and 59.3% vs 74.1%,respectively. Conclusion For lower limb arterial occlusion, endovascular treatment can improve the blood flow perfusion, save the limb and improve the quality of life of patients in short term. While, the long-term results should be further observed.