腔内介入治疗腘动脉硬化病变的随访结果

Follow-up Results of Endovascular Treatment for Popliteal Arteriosclerotic Disease

目的探讨介入治疗腘动脉硬化病变的治疗效果。方法回顾性分析2008年1月～2013年2月91例（96条肢体）腘动脉硬化病变行介入治疗的临床资料,病变位于P1段44条,P2段7条,P1～P2段35条,P1～P3段10条。狭窄性病变（狭窄率〉50%）42条,闭塞性病变54条。单纯球囊扩张成形35条,球囊扩张支架置入61条。闭塞性病变均采用球囊扩张支架置入术。结果介入治疗腘动脉成功率100%,出院前踝肱指数（ankle brachial index,ABI）由术前0.45±0.15升高至0.89±0.17（t=-8.522,P=0.001）。84例（87条肢体）随访12～74个月,（39.0±10.3）月,随访率92.3%（84/91）。术后12个月腘动脉一期通畅率70.1%（61/87）,二期通畅率89.7%（78/87）。腘动脉硬化狭窄性病变中,单纯球囊扩张成形32条肢体的12个月一期通畅率90.6%（29/32）,二期通畅率96.9%（31/32）;球囊扩张支架置入6条肢体的12个月一期通畅率50.0%（3/6）,二期通畅率83.3%（5/6）;球囊扩张成形术一期通畅率明显高于球囊扩张支架置入术（Fisher精确检验,P=0.039）。结论介入治疗腘动脉硬化病变效果良好,腘动脉硬化狭窄性病变球囊扩张成形术近期通畅率优于球囊扩张支架置入术。

Objective To evaluate the effect of endovascular treatment for popliteal arteriosclerotic disease. Methods A retrospective review was done based on clinical data of 91 patients with popliteal arteriosclerotic disease（ 96 limbs） between January2008 and February 2013. The lesions were located at P1 segment in 44 limbs,P2 segment in 7 limbs,P1- P2 segment in 35 limbs,and P1- P3 segment in 10 limbs. There were stenosis lesions（ 50%） in 42 limbs and occlusive lesions in 54 limbs. The lesions were treated with percutaneous transluminal angioplasty（ PTA） in 35 limbs and PTA and stent placement in 61 limbs. All the occlusive lesions were treated with PTA and stent placement. Results The success rate of endovascular treatment was 100%. The ankle brachial index（ ABI） was increased from 0. 45 ± 0. 15 to 0. 89 ± 0. 17（ t =- 8. 522,P = 0. 001）. Follow-ups were carried out for12- 74 months（ 39. 0 ± 10. 3 months） in 84 patients（ 87 limbs）,the follow-up rate being 92. 3%（ 84 /91）. At 12 months after operation,the primary patency rate was 70. 1%（ 61 /87） and the secondary patency rate was 89. 7%（ 78 /87）. For stenosis arteriosclerotic disease（ 32 limbs）,the primary patency rate of PTA was 90. 6%（ 29 /32） and the secondary patency rate was 96. 9%（ 31 /32） after 12 months. For PTA and stent placement（ 6 limbs）,the primary patency rate was 50. 0%（ 3 /6） and the secondary patency rate was 83. 3%（ 5 /6） after 12 months. The primary patency rate was significantly higher in PTA than PTA and stent placement（ Fisher＇s Exact Test,P = 0. 039）. Conclusions Endovascular treatment for popliteal arteriosclerotic disease has good results. The short-term patency rate is better in PTA than PTA and stent placement.