摘要
目的评价内膜下成形技术治疗糖尿病患者踝下动脉闭塞性病变的可行性和安全性。方法内膜下成形术用于治疗37例伴有严重下肢缺血症状,足背动脉和(或)足底动脉闭塞性病变的糖尿病患者。所有患者均不适合血管腔内成形术或外科血管旁路移植术治疗。57条患肢中,31条(54.4%)有组织缺损,51条(89.5%)肢体表现为静息痛。患者的临床症状,足背动脉或者足底动脉的搏动评分和踝-臂指数(ABI)在行内膜下成形技术前后进行比较。随访过程中评估伤口愈合、截肢和靶血管的再狭窄情况。Kaplan-Meier生存曲线用于评价接受治疗患者的肢体挽救率、生存率和免截肢率。结果 57条患肢共66处踝下动脉病变中的55处(83.3%)成功行内膜下成形技术治疗。平均动脉搏动评分和ABI从术前的0.33±0.54和0.31±0.19分别改善为术后的2.04±1.05和0.80±0.14(P<0.01)。术后30 d内1例患者(2.7%)死亡,5例(13.5%)患者发生包括出血,血栓形成或者血管痉挛等轻微并发症。12个月随访时,Kaplan-Meier评分显示肢体挽救率为94.6%,免截肢率为89.2%,生存率为97.3%。结论足背动脉和(或)足底动脉的内膜下成形技术对于具有严重下肢缺血症状而不适合外科血管旁路移植手术治疗的糖尿病患者的肢体挽救率是有效的。
Objective To assess the feasibility and efficacy of subintimal angioplasty(SA)for the treatment of below-the-ankle arterial occlusion in diabetic patients with chronic critical limb ischemia(CLI).Methods SA was adopted for 57 diseased lower limbs in 37 diabetic patients with chronic CLI and occlusive disease of the dorsalis pedis artery(DPA)and/or planter artery(PA),who were not suitable candidates for intraluminal angioplasty or bypass surgery.Of the total 57 diseased lower limbs,tissue loss was seen in 31(54.4%)and rest pain was reported in 51(89.5%).SA was carried out to create continuous arterial flow to the foot for limb salvage.Both before and after the procedure the clinical symptoms,DPA or PA pulse volume scores and ankle-brachial indexes(ABI)were determined in all patients,the results were compared and statistically analysed.During the follow-up period,the healing of the wound,the salvage of the diseased limb and the re-stenosis occurrence of the target vessels were evaluated.Kaplan-Meier curves were constructed to evaluate limb salvage,survival rate and freedom from amputation.Results A total of 66 below-the-ankle arterial lesions were detected in 57 affected limbs.Of the 66 lesions,SA was successfully performed in 55(83.3%).Before SA the median pulse volume scores and ABIs were 0.33 ± 0.54 and 0.31 ± 0.19 respectively,which became 2.04 ± 1.05 and 0.80 ± 0.14 respectively after SA,the differences in both median pulse volume scores and ABI were statistically significant(P 0.01 for both).One patient(2.7%)died within 30 days after the procedure.Mild complications,such as bleeding,thrombosis or angiospa-sm etc.occurred in five patents(13.5%).Twelve months after SA,Kaplan-Meier analysis showed that the limb salvage rate was 94.6%,the freedom from amputation was 89.2% and the survival rate was 97.3%.Conclusion SA of the dorsalis pedis artery and/or planter artery is an effective technique for lower limb salvage in diabetic patients with chronic CLI who are not s
出处
《介入放射学杂志》
CSCD
北大核心
2011年第3期196-201,共6页
Journal of Interventional Radiology
关键词
动脉闭塞
严重下肢缺血
足背动脉
足底动脉
内膜下成形
糖尿病足
arterial occlusion
critical limb ischemia
dorsalis pedis artery
planter artery
subintimal angioplasty
diabetic foot