腔内治疗老年下肢动脉硬化闭塞症的近期疗效观察

Short-term Therapeutic Effect of Intracavitary Treatment for Lower Extremity Arteriosclerosis Obliterans

目的探讨腔内治疗老年下肢动脉硬化闭塞症的近期疗效。方法回顾性分析2010年1月~2016年6月行腔内治疗的老年下肢动脉硬化闭塞症112例(140条肢体)资料,术后3、6、12个月随访治疗效果。结果成功开通病变肢体129条,手术技术成功率92.1%(129/140),治疗病变血管164支。术后3、6和12个月下肢缺血临床症状Fontaine分期与术前比较均改善(P<0.01)。术后3、6和12个月足背动脉踝肱指数均较术前的0.56±0.32显著增加,分别为0.97±0.11(t=-13.572,P=0.000),0.85±0.23(t=-11.588,P=0.000),0.71±0.26(t=-6.661,P=0.000)。术后3、6和12个月靶血管的再狭窄率分别为14.4%(23/160)、28.2%(42/149)和43.8%(63/144),无截肢。结论腔内治疗老年下肢动脉硬化闭塞症微创、安全、有效,能迅速恢复下肢血流,改善缺血症状,避免截肢,近期疗效满意。

Objective To explore the short-term clinical efficacy of intracavitary treatment of lower extremity arteriosclerosis obliterans in the elderly. Methods A retrospective analysis on 112 cases of elderly patients with lower extremity arteriosclerosis obliterans（ 140 limbs） treated at our hospital from January 2010 to June 2016 was carried out. The effects of endovascular treatment were followed at 3 months,6 months and 12 months after operation. Results A total of 140 limbs were treated by interventional therapy,129 of which were opened,with a technical success rate of 92. 1%（ 129/140）. The clinical symptoms of lower extremity ischemia at 3 months,6 months and 12 months after operation were improved as compared with those before operation according to the Fontaine classification（ all P〈0. 01）. The ankle-brachial index of dorsalis pedis artery was increased form 0. 56 ± 0. 32 preoperatively to 0. 97 ± 0. 11（ t =-13. 572,P = 0. 000）,0. 85 ± 0. 23（ t =-11. 588,P = 0. 000）,and 0. 71 ± 0. 26（ t =-6. 661,P = 0. 000）at 3,6 and 12 months after operation,respectively. The re-stenosis rates of target vessels at 3,6 and 12 months after operation were14. 4%（ 23/164）,28. 2%（ 42/149） and 43. 8%（ 63/144）, respectively. No amputation was required. Conclusions Endovascular treatment for elderly patients with arteriosclerosis obliterans is a minimally invasive,safe and effective treatment. It can quickly restore blood flow in the lower limb,relieve lower limb ischemic symptoms,increase limb preservation rate and enhance the quality of life. The short-term clinical results are satisfactory.