老年女性动脉硬化闭塞症的特点及腔内治疗效果评价

Characteristics of arteriosclerosis obliterans in elderly women and assessment of endovascular treatment

目的探讨老年女性动脉硬化闭塞症患者的特点及腔内治疗的预后情况。方法回顾性总结2015年3月至2016年3月山西大医院血管外科收治的106例下肢动脉硬化闭塞症老年患者的临床资料。其中男性54例,年龄60~89(68.3±13.4)岁;女性52例,年龄59~90(77.3±7.7)岁。全部患者接受下肢动脉腔内治疗,比较男性与女性之间的一般资料及术后随访情况,总结分析女性患者患病因素及腔内治疗效果评价。采用SPSS 22.0统计学软件进行分析。计数资料比较采用χ~2检验。结果全部患者进行腔内手术并随访,手术成功率99.1%(1例男性多节段病变未开通),随访率94.3%。与男性患者相比,老年女性的发病年龄更大,吸烟者少,合并高血压患者多,且股动脉以远病变患者比例更大,病变程度更重(均P<0.05)。围手术期严重并发症4例(3.85%),其中2例心肌梗死均为女性。随访期内死亡3例(男性2例,女性1例),截肢5例(男性3例,女性2例),并发心脑血管事件11例(男性2例,女性9例),支架内再狭窄17例(男性13例,女性4例)。比较两性患者的随访数据,结果显示,腔内治疗后老年女性患者再栓塞率低于男性(χ~2=5.085,P=0.024),但并发心脑血管事件发生率显著高于男性(χ~2=5.271,P=0.022)。结论老年女性下肢动脉硬化患者平均发病年龄更大,且多合并高血压病,但吸烟者明显少于男性,病变程度更重。腔内治疗后老年女性患者再栓塞率低于男性,但并发心脑血管事件发生率明显升高。

Objective To investigate the characteristics and prognosis of arteriosclerosis obliterans in the elderly women.Methods A retrospective analysis was performed of 106 elderly patients（54 males and 52 females） from March 2015 to March 2016 with arteriosclerosis obliterans. The 54 male patients were 60-89（ 68. 3 ± 13. 4） years old,and 52 female patients 59-90（77. 3 ± 7. 7） years old. All the patients received endovascular treatment of lower extremity arteries. The two gender groups were compared in terms of the general data and postoperative follow-up,and the female patients were analyzed for the prevalence factors and efficacy of endovascular treatment. SPSS statistics 22. 0 was used for data analysis,and Chi-square test for comparison of enumeration data. Results All patients underwent endoluminal surgery and were followed up,with a success rate of 99. 1%（ failed recanalization in 1 male patient with multi-segment lesions） and a follow-up rate of 94. 3%. The female group were significantly advanced in age（P 0. 05）,with fewer smokers（P 0. 05）,more complicated with hypertension（P 0. 05）,greater proportion with distant femoral lesions（ P 0. 05） and more severe lesions（ P 0. 05）. Perioperative complications occurred in 4 serious patients（3. 85%）,2 of whom were female and had myocardial infarction. During the follow-up,in-stent restenosis occurred in 17 patients（ 13 males and 4 females） and,3（2 males and 1 female） died,5（3 males and 2 females） amputated. Cardiovascular and cerebrovascular events were reported in 11 patients（2 males and 9 females）. Conclusion Compared with the males,the elderly females have a higher average age of onset of lower extremity arteriosclerosis,a higher proportion of concomitant hypertension,a significant smaller number of smokers,and more severe lesions. The elderly females show a lower rate of re-embolism after endovascular treatment than the males,but the incidence of concurrent cardiovascular and cerebrovascular events is significantly higher.