期刊文献+

内膜下成形技术治疗慢性下肢重度缺血糖尿病患者踝下动脉闭塞性病变的临床研究 被引量:6

Subintimal angioplasty for below-the-ankle arterial occlusion in diabetic patients with chronic critical limb ischemia
下载PDF
导出
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
  • 相关文献

参考文献5

  • 1Pomposelli FB Jr, Mareaccio E J, Gibbons GW, et al. Dorsalis pedis arterial bypass: durable limb salvage for foot ischemia in patients with diabetes mellitus[J]. J Vasc Surg, 1995, 21 : 375 - 384. 被引量:1
  • 2Myers SI, Myers D J, Ahmend A, et al. Preliminary results of subintimal angioplasty for limb salvage in lower extremities with severe chronic ischemia and limb-threatening isehemia [J]. J Vasc Surg, 2006, 44:1239 - 1246. 被引量:1
  • 3Fusaro M, Dolla Paolab LD, Brigato C, et al. Plantar to dorsalis pedis artery subintimal angioplasty in a patient with critical foot ischemia: a novel technique in the armamentarium of the peripheral interventionist [J]. J Cardiovasc Med, 2007, 8:977 - 980. 被引量:1
  • 4Spinosa DJ, Leung DA, Matsumoto AH, et al. Percutaneous intentional extraluminal recanalizatlon in patients with chronic critical limb ischemia [J]. Radiology, 2004, 232:499 - 507. 被引量:1
  • 5Scott EC, Biuckians A, Light RE, et al. Subintimal angioplasty: Our experience in the treatment of 506 infrainguinal arterial occlusions [J]. J Vasc Surg, 2008, 48: 878- 88d. 被引量:1

同被引文献63

  • 1Bown MJ,Bolia A,Sutton AJ.Subintimal angioplasty: meta-analytical evidence of clinical utility[J].Eur J Vasc Endovasc Surg,2009,38: 323 - 337. 被引量:1
  • 2Fusaro M,Dalla Paola L,Brigato C,et al.Plantar to dorsalis pedis artery subintimal angioplasty in a patient with critical foot ischemia: a novel technique in the armamentarium of the peripheral interventionist[J].J Cardiovasc Med (Hagerstown),2007,8: 977 - 980. 被引量:1
  • 3Wang JB,Zhao JG,Li MH,et al.An effective guidewire looping technique for the recanalization of occlusive segments of infrapopliteal vessels[J].Korean J Radiol,2010,11: 441 - 448. 被引量:1
  • 4Chomel S,Douek P,Moulin P,et al.Contrast- enhanced Mr angiography of the foot: anatomy and clinical application in patients with diabetes[J].Am J Roentgenol,2004,182: 1435 - 1442. 被引量:1
  • 5Taylor GI,Palmer JH.The vascular territories (angiosomes) of the body: experimental study and clinical applications[J].Br J Plast Surg,1987,40: 113 - 141. 被引量:1
  • 6Iida O,Nanto S,Uematsu M,et al.Importance of the angios-ome concept for endovascular therapy in patients with critical limb ischemia[J].Catheter Cardiovasc Interv,2010,75: 830 - 836. 被引量:1
  • 7Attinger CE,Evans KK,Bulan E,et al.Angiosomes of the foot and ankle and clinical implications for limb salvage:Reconstruction,incisions,and revascularization[J].Plast Reconstr Surg,2006,117(suppl):261S - 263S. 被引量:1
  • 8Neville RF,Attinger CE,Bulan EJ,et al.Revascularization of a specific angiosome for limb salvage: does the target artery matter?[J].Ann Vasc Surg,2009,23: 367 - 373. 被引量:1
  • 9Alexandrescu VA,Hubermont G,Philips Y,et al.Selective primary angioplasty following an angiosome model of reperfusion in the treatment of Wagner 1- 4 diabetic foot lesions: practice in a multidisciplinary diabetic limb service[J].J Endovasc Ther,2008,15: 580 - 593. 被引量:1
  • 10Alexandrescu V,Vincent G,Azdad K,et al.A reliable appr-oach to diabetic neuroischemic foot wounds: below- the- knee angiosome- oriented angioplasty[J].J Endovasc Ther,2011,18: 376 - 387. 被引量:1

引证文献6

二级引证文献41

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部