糖尿病足下肢动脉血管成像和血管内治疗临床分析

Clinical analysis of diabetic foot lower extremity arterial angiography and endovascular treatment

目的:分析糖尿病足下肢动脉血管的DSA影像特征和血管内治疗的临床效果,为糖尿病足临床介入治疗提供依据。方法:对17例糖尿病足的下肢动脉行DSA血管造影,证实全部患肢的供血动脉显示血管不同程度的狭窄、闭塞性病变。根据下肢动脉血管狭窄程度依次采用以下介入治疗方法:血管内抗凝溶栓治疗;靶血管内球囊扩张术(PTA);靶血管内支架植入术。留置造影导管后,经导管注入尿激酶(万U):肝素钠(mg):NS(m L)为1:1:1的抗凝溶栓溶液,用量2.0 m L/h,用微量泵维持5 d左右。结果:靶血管周围侧枝血管明显增多,占全组病例的100%,狭窄段血管腔较前扩张占70.3%,闭塞段血管重新开通占60.5%。0~Ⅱ级病足溃疡面愈合,Ⅲ~Ⅳ级病足溃疡面干燥、缩小、周围炎症消退。结论:DSA血管造影可以早期诊断糖尿病下肢血管病变的程度、范围。介入治疗能改善患足的血供,从而预防控制糖尿病足的发生、发展。

Objective:To analyze the clinical effect of diabetic foot lower extremity arterial angiography and endovascular treatment,to provide the basis for diabetic foot clinical intervention.Methods:Lower extremity arterial DSA angiography was performed in 17 cases of diabetic foot,all confirmed limb artery display varying degrees of vascular stenosis,occlusive disease.According to the degree of lower extremity arterial stenosis in turn used the following interventional therapy:endovascular anticoagulant and thrombolytic therapy;within the target vessel balloon angioplasty(PTA);within the target vessel stenting.After the indwelling catheter,the catheter urokinase(Wan U):heparin(mg):NS(m L)of 1:1:1 solution of anticoagulant thrombolysis,the amount of 2.0 ml/h,with a micro pump to maintain about 5 d.Results:Target vessels around the collateral vessels increased,accounting for100% of all the cases, the stenosis segment vascular cavity is the expanding accounted for 70.3%,occlusive segment vascular reopened accounts for 60.5%.0~Ⅱ class disease foot ulcer healing, Ⅲ ~Ⅳ class foot ulcer surface drying,peripheral inflammation subsided.Conclusion:DSA angiography may be an early diagnosis of peripheral vascular disease extent.Interventional treatment can improve blood supply of the foot,thus preventing the occurrence of diabetic foot control and development.