经皮腔内血管成形术治疗糖尿病患者下肢动脉病变

目的评价经皮腔内血管成形术治疗糖尿病患者下肢缺血的疗效。方法回顾分析我科2008年5月～2012年3月经皮腔内血管成形术治疗2型糖尿病下肢缺血89例的l临床资料,记录其内科情况、股胭动脉TASC（泛大西洋协作组）Ⅱ分级、流出道评分、Rutherford分期以及术后30天并发症。随访计算一期通畅率（Kaplan—Meier）、分级情况、保肢率,观察其疗效。结果共89例108条患肢。年龄（70．5±8．6）岁。术前踝肱指数（ABI）中位数0．36（0～0．73）,术后1个月0．79（0．33～1．15,Z=-3．276,P=0．001）。术前胫腓动脉流出道评分中位数7．5分（3．5～10分）,术后即刻中位数6．0分（1．5～9分,Z=-2．948,P=0．003）。股胭及膝下胫腓动脉腔内血管成形术技术成功率分别为97．2％（105／108）和93．3％（98／105）。随访患者86例105条患肢。中位随访时间13个月（5～46个月）,随访期间死亡3例,均死于急性心肌梗死,随访率90．7％（78／86）。术后1年股胭动脉一期通畅率67．3％,胫腓动脉为56．3％,1年保肢率91．9％（34／37）,1年时症状缓解率83．3％（90／108）。结论经皮腔内血管成形术治疗糖尿病合并下肢动脉闭塞性病变症状缓解明显,有较高的保肢率,可以作为糖尿病合并下肢动脉闭塞性病变．特别是膝下病变治疗的首选．远期疗效有待讲一步观察．     

股浅动脉闭塞122例治疗体会

目的总结股浅动脉支架与股-腘动脉人工血管旁路移植术治疗股浅动脉闭塞病变的效果。方法选取我院2008年1月至2011年4月期间接受经皮腔内血管成形术+支架置入术(简称"PTA/S术组")或股-腘动脉人工血管旁路移植术(简称"动脉旁路移植术组")治疗股浅动脉闭塞病变的122例患者(136条患肢)作为研究对象。记录患者的年龄、住院时间、术前合并症、术后并发症、TASCⅡ分级、远端流出道情况、一期通畅率、有无截肢、死亡等。结果 1 PTA/S术组有64例74条患肢,动脉旁路移植术组有58例62条患肢,PTA/S术组患者的年龄大于动脉旁路移植术组(P0.05);PTA/S术组TASCⅡA、B级病变肢体所占比例较动脉旁路移植术组高(P0.05),TASCⅡC、D级病变肢体所占比例较动脉旁路移植术组低(P0.05);PTA/S术组拥有1条和3条远端流出道血管的患肢数目分别较动脉旁路移植术组多(P0.05);2组患者拥有2条远端流出道血管的患肢数目、术前合并糖尿病、合病高血压、合病糖尿病及高血压以及术前吸烟史病例数比较差异均无统计学意义(P0.05)。2 2组患者均无围手术期死亡患者;PTA/S术组的住院时间短于动脉旁路移植术组〔(7.2±1.2)d和(14.1±1.4)d,P0.05〕;而术后3年死亡率PTA/S术组高于动脉旁路移植术组(4.7%比1.7%,P0.05);切口感染率PTA/S术组低于动脉旁路移植术组(0比3.2%,P0.05);2组患者截肢率比较差异无统计学意义(P0.05);2组患者术后6、12及24个月一期通畅率比较差异无统计学意义(P0.05),36个月一期通畅率动脉旁路移植术组明显高于PTA/S术组(50.0%比40.5%,P0.05)。结论对于股浅动脉闭塞采用股-腘动脉人工血管旁路移植术能够获得较高的远期通畅率,但住院时间较长,个别患者会发生切口感染。股浅动脉球囊扩张成形+支架置入术手术创伤小,患者恢复快,住院时间短,对于年龄大,身体状况较差不能耐受股-腘动脉人工血管旁路移植术的患者有重要意义,但其远期通畅率有待进一步提高。     

TASCⅡC、D型股胭动脉闭塞腔内治疗的操作技巧与疗效分析

目的 观察TASCⅡC、D型股胭动脉闭塞腔内治疗的临床疗效,分析影响治疗效果的可能因素与操作技巧.方法 2009年1月～20lO年6月,89例(113条患肢)TAsCⅡC、D型股胭动脉闭塞患者接受腔内治疗.对患者术后3、6和12个月时的临床症状、踝肱指数(ABI)、并发症发生率和累计通畅率进行分析.结果 成功开通病变肢体共106条,技术成功率93.8%.36条(34.0%)患肢出现并发症.75例患者(共92条下肢)获得随访,随访率为86.8%.平均随访时间12.5个月.术后3、6和12个月时的平均ABI分别为0.74±0.39、0.68±0.38和0.66±0.31,与术前比较(0.43±0.39),差异均有统计学意义(P＜0.01).术后12个月的一期通畅率、辅助通畅率和二期通畅率分别为64.6%、72.4%和81.5%.结论 TASCⅡC、D型股腘动脉闭塞腔内治疗是一种安全有效的方法.熟练的腔内操作技术和规范的术后指导是提高技术成功率和维持动脉早中期通畅的关键.     

腔内支架植入治疗TASCⅡ C、D型股腘动脉慢性闭塞病变

目的 探讨泛大西洋协作组织(TransAtlantic InterSociety Consensus,TASC)ⅡC、D型股腘动脉慢性闭塞腔内支架治疗的临床疗效.方法 回顾性分析2008年1月至2011年6月46例(51条下肢)TASCⅡC型和D型股腘动脉闭塞患者腔内治疗的临床资料.46例中男27例,女19例,年龄52～88岁,平均(70 ±8)岁.术前Rutherford症状分级:3级重度间歇性跛行29条,4级静息痛12条,5级轻微组织缺损6条,6级组织溃疡、坏疽4条.总结分析技术成功率、患肢术后临床症状、踝肱指数(ankle brachial index,ABI)变化,并发症发生率和通畅率.结果 技术成功率90.2％ (42/51),治疗成功者共植入支架93枚.术后ABI 0.71 ±0.23,较术前0.42 ±0.13提高,两者差异有统计学意义(t=-7.281,P＜0.01).42例技术成功者均获随访,平均随访(14.6±1.2)个月.术后6个月的一期通畅率、辅助通畅率和累积通畅率分别为81.0％、88.1％、90.5％,术后12个月的一期通畅率、辅助通畅率和累积通畅率分别为66.7％、71.8％、79.5％.结论 TASCⅡC、D型股腘动脉慢性闭塞腔内治疗是一种安全有效的方法.     

动脉自膨式支架置入治疗下肢缺血

目的探讨下肢各个部位动脉腔内自膨式支架置入治疗下肢缺血的疗效。方法对2002年1月-2006年3月支架治疗65例71条患肢的临床资料进行临床回顾性研究，其中52．3％（38／71）肢体为糖尿病下肢动脉硬化，47、7％（33／71）肢体为非糖尿病下肢动脉硬化。支架部位包括腹主动脉支架2例2条患肢2枚支架，腹主动脉及髂动脉闭塞行腹主动脉和单侧髂动脉支架置入1例3枚支架，髂动脉支架33例35条患肢38枚支架，髂动脉和股浅动脉同时支架置入6例6条息肢12枚支架，股浅动脉支架置入16例19条肢体23枚支架，股浅动脉和近端胭动脉病变同时支架置入5例6条患肢10枚支架，远端胭动脉支架2例2条患肢。结果65例随访2—50个月，平均16．1月，2例腹主动脉支架、1例腹主动脉与髂动脉支架同时置入全部通畅；髂动脉支架闭塞4例4条患肢，通畅率88．6％（31／35）；股浅动脉支架闭塞4例4条患肢，通畅率为78．9％（15／19）；股浅动脉与近端胭动脉支架闭塞1例，通畅率83．3％（5／6）；远端胭动脉支架2例全部闭塞；3例小腿动脉流出道主干动脉全部闭塞的支架术后平均5．6月仍然保持通畅。结论下肢动脉腔内支架置入可作为治疗主髂动脉病变的首选方法；对于股动脉和近段胭动脉病变也可根据情况适当选用，尤其是年老体弱，无法耐受动脉旁路移植手术的患者，也可以作为首选方法；对于膝下小动脉病变应慎重使用支架。     

杂交手术治疗TASC D型下肢动脉硬化闭塞症的临床分析

目的 评价杂交手术治疗TASC D型下肢动脉硬化闭塞症的临床疗效.方法 回顾性分析2006年1月至2009年12月间采用杂交手术治疗的46例TASC D型下肢动脉硬化闭塞症患者(共48条患肢)的临床资料.其中男性32条患肢,女性16条患肢;年龄54～85岁,平均67岁.根据临床症状进行Fontaine分级,根据开放手术与腔内治疗部位的相对关系进行分组,采用Kaplan-Meier生存曲线比较不同分级、分组患者间一期通畅率的差异,分析影响一期通畅率的危险因素.结果 所有患者手术均获成功.术后41条患肢(85.4%)临床症状明显改善,平均踝肱指数0.63±0.18,高于术前的0.24±0.13(P＜0.05);平均间歇性跛行距离从术前(87±48)m提高至(247±62)m(P＜0.05).平均随访27.1个月,一期通畅率为79.2%,辅助一期通畅率为83.3%,二期通畅率为95.8%.生存分析显示FontaineⅡ级患者一期通畅率明显高于Ⅲ、Ⅳ级(P均＜0.05);当对开放手术治疗动脉段的远近端都进行腔内干预时,其一期通畅率要低于仅在其近端或远端一侧干预者(P值均＜0.05).Cox回归分析发现糖尿病和高血脂是影响术后一期通畅率的独立因素(P=0.013、0.008).结论 杂交手术是治疗TASC D型下肢动脉硬化闭塞症的有效方法,适用于高危重症患者.     

股腘动脉慢性长段闭塞腔内治疗134例临床分析

目的观察TASCⅡC、D型股胭动脉慢性长段闭塞腔内治疗的临床疗效,总结腔内治疗相关并发症和防治方法。方法2009年1月至2010年12月,134例（172条下肢）TASCⅡC、D型股胴动脉闭塞患者接受腔内治疗。回顾性分析技术成功率、患肢术后临床症状、踝肱指数（ankle brachial index,ABI）变化、并发症发生率和通畅率。结果技术成功率90．7％。43条患肢（83条次）出现并发症（27．6％）。其中动脉夹层29条（34．9％）,动脉穿孔11条（13．3％）,动脉栓塞8条（9．6％）,穿刺部位血肿16条（19．3％）,穿刺点假性动脉瘤5条（6．0％）,急性动脉血栓形成3条（3．6％）,造影剂过敏反应3条（3．6％）,尿路出血2条（2．4％）和心脑血管意外6条（7．2％）。平均随访13．1个月。术后12个月的一期通畅率、辅助通畅率和二期通畅率分别为61．1％、70．2％、81．7％。结论TASCⅡC、D型股胭动脉闭塞腔内治疗是一种安全有效的方法。熟练的腔内操作技术,及时正确的并发症处理和规范的术后随访是提高治疗成功率和维持动脉长期通畅的关键。     

TASC C/D型主髂动脉硬化闭塞症的杂交手术治疗

目的:评价杂交手术治疗TASC C/D型主髂动脉硬化闭塞症的临床疗效。方法:回顾性分析2012年5月—2014年5月采用杂交手术治疗的48例TASC C/D型主髂动脉硬化闭塞症患者(共66条患肢)临床资料,其中TASC C型22例,D型26例,观察围手术期情况,比较不同Fontaine分级患者血管再通情况并分析影响一期通畅率的因素。结果:48例(66条患肢)杂交手术均获得成功,手术成功率100%,1例患者因下肢坏疽处感染严重而于术后5 d行截肢手术,无死亡病例,围手术期并发症发生率16.67%。与术前比较,术后间歇性跛行距离(568 m vs.92 m)与踝肱指数(0.75 vs.0.25)均明显增加(均P0.05)。平均随访24个月,术后6个月和1、2年的一期通畅率分别为95.45%、90.91%、87.88%,二期通畅率分别为98.48%、96.97%、92.42%;Fontaine II、III级患者一期通畅率均高于IV级患者(P=0.036、0.015),而II、III级患者之间一期通畅率无统计学差异(P0.05);高脂血症和糖尿病是影响术后一期通畅率的独立危险因素(P=0.026、0.003)。结论:杂交手术是治疗TASC C/D型主髂动脉硬化闭塞症的安全、有效方式。     

逆行开通技术治疗TASCⅡ C/D型股腘动脉硬化闭塞症

目的探讨逆行开通技术治疗TASCⅡ C/D型股腘动脉闭塞病变的价值。方法回顾性分析于我院接受逆行开通技术治疗的TASCⅡ C/D型股腘动脉硬化闭塞症患者36例。比较术前与术后踝肱指数(ABI)及间歇性跛行距离,分析术后血管通畅率及并发症。结果 36例均成功开通,术后7天及3、6、12个月间歇性跛行距离和ABI均较术前均明显增加(P均0.05)。术后3、6及12个月患肢血管通畅率分别为97.22%、91.67%及72.22%。随访期间无死亡或截肢,围手术期并发症发生率11.11%(4/36)。结论逆行开通技术可作为顺行开通TASCⅡ C/D型股腘动脉硬化闭塞症失败后的一种补救方法。     

自膨式裸支架LifeStent在髂动脉硬化闭塞疾病治疗中的疗效分析

目的评价腔内技术对治疗髂动脉狭窄闭塞性疾病的近中期疗效。方法回顾性分析济宁市第一人民医院2011年6月至2014年6月期间使用第2代自膨式裸支架Life Stent(美国,巴德)置入治疗的64例髂动脉硬化闭塞疾病患者(共75条患肢)的临床资料,分析其保肢率、通畅率、并发症发生率等。结果本组患者平均年龄为68岁,按泛大西洋协作组织共识(TASC)Ⅱ分型,TASCⅡA型患肢11条,TASCⅡB型患肢26条,TASCⅡC型患肢29条,TASCⅡD型患肢9条。术前踝肱指数为0.29±0.20,术后复查踝肱指数为0.94±0.16,术后踝肱指数明显高于术前(P0.01)。术后随访(22±10)个月,失访5例。1年、2年的一期累积通畅率分别为79%和60%、二期累积通畅率分别为91%和84%、保肢率分别为96%和94%。围手术期发生并发症5例,并发症发生率为7.8%,无手术相关死亡及严重并发症发生。结论第2代自膨式裸支架Life Stent治疗髂动脉狭窄闭塞疾病的近中期临床疗效较满意,远期疗效尚需进一步观察。     

股腘动脉闭塞症的手术治疗

目的 探讨股腘动脉旁路移植术治疗下肢动脉硬化闭塞症(C、D级病变)的近中期疗效.方法 2005年1月至2009年2月,170例患者(191条肢体)行股动脉以远血管重建术.其中男性108例,女性62例;年龄45～85岁,平均67岁.症状包括间歇性跛行78例,静息痛62例,下肢缺血性溃疡19例,远端组织坏死11例.所有患者术前均行动脉造影检查,根据TASC Ⅱ分级:C级病变127条肢体,D级病变64条肢体.手术方法包括大隐静脉原位旁路移植术15条肢体,大隐静脉转位20条肢体,人工血管旁路移植术128条肢体,大隐静脉与人工血管组合旁路移植术28条肢体.结果 围手术期无死亡病例.术后随访6～36个月,平均(24±6)个月;76例失访,随访率57%(109/191).一期通畅率84.4%(92/109),其中人工血管旁路移植通畅率88.2%(75/85),大隐静脉(原位、转位、组合)旁路移植通畅率70.8%(17/24).二期通畅率89.9%(98/109).结论 人工血管旁路移植术是治疗严重股腘动脉闭塞症(TASC C和D级病变)的主要方法,手术疗效满意.     

Contemporary outcomes after superficial femoral artery angioplasty and stenting: the influence of TASC classification and runoff score

OBJECTIVE: A recent randomized trial suggested nitinol self-expanding stents (SES) were associated with reduced restenosis rates compared with simple percutaneous transluminal angioplasty (PTA). We evaluated our results with superficial femoral artery (SFA) SES to determine whether TransAtlantic InterSociety Consensus (TASC) classification, indication for intervention, patient risk factors, or Society of Vascular Surgery (SVS) runoff score correlated with patency and clinical outcome, and to evaluate if bare nitinol stents or expanded polytetrafluoroethylene (ePTFE) covered stent placement adversely impacts the tibial artery runoff. METHODS: A total of 109 consecutive SFA stenting procedures (95 patients) at two university-affiliated hospitals from 2003 to 2006 were identified. Medical records, angiographic, and noninvasive studies were reviewed in detail. Patient demographics and risk factors were recorded. Procedural angiograms were classified according to TASC Criteria (I-2000 and II-2007 versions) and SVS runoff scores were determined in every patient; primary, primary-assisted, secondary patency, and limb salvage rates were calculated. Cox proportional hazard model was used to determine if indication, TASC classification, runoff score, and comorbidities affected outcome. RESULTS: Seventy-one patients (65%) underwent SES for claudication and 38 patients (35%) for critical limb ischemia (CLI). Average treatment length was 15.7 cm, average runoff score was 4.6. Overall 36-month primary, primary-assisted, and secondary rates were 52%, 64%, and 59%, respectively. Limb salvage was 75% in CLI patients. No limbs were lost following interventions in claudicants (mean follow-up 16 months). In 24 patients with stent occlusion, 15 underwent endovascular revision, only five (33%) ultimately remained patent (15.8 months after reintervention). In contrast, all nine reinterventions for in-stent stenosis remained patent (17.8 months). Of 24 patients who underwent 37 endovascular revisions for either occlusion or stenosis, eight (35%) had worsening of their runoff score (4.1 to 6.4). By Cox proportional hazards analysis, hypertension (hazard ratio [HR] 0.35), TASC D lesions (HR 5.5), and runoff score > 5 (HR 2.6) significantly affected primary patency. CONCLUSIONS: Self-expanding stents produce acceptable outcomes for treatment of SFA disease. Poorer patency rates are associated with TASC D lesions and poor initial runoff score; HTN was associated with improved patency rates. Stent occlusion and in-stent stenosis were not entirely benign; one-third of patients had deterioration of their tibial artery runoff. Future studies of SFA interventions need to stratify TASC classification and runoff score. Further evaluation of the long-term effects of SFA stenting on tibial runoff is needed.     

Efficacy of Viabahn in the treatment of severe superficial femoral artery lesions: which factors influence long-term patency?

PURPOSE: To evaluate superficial femoral artery (SFA) occlusive disease treatment by means of covered stents. STUDY DESIGN: retrospective. METHOD: From 2000 to 2005, a Hemobahn/Viabahn endoprosthesis was implanted in 102 limbs (95 patients; mean age: 72.1 years, 52-94) for intermittent claudication (group I, n=50 limbs), critical (group II, n=32) or acute ischemia (group III, n=20). Lesions treated were Trans-Atlantic Inter-Society Consensus (TASC) A (n=9) B (n=42), C (n=28) or D (n=23), associated with a good (2 or 3 leg arteries, n=60) or a poor (1 or 0 artery, n=42) runoff. RESULTS: The endograft was placed successfully in all cases, but 3 early deaths (3.2%) (1 in group II and 2 in group III), and 4 acute thromboses (4%) occurred. Primary and secondary actuarial patency rates were 97+/-1.7%, and 99+/-1% at 1 month, 74+/-4.8% & 84+/-4.1% at 1 year,and 71+/-9.5% & 79+/-8.5% at 3 years, after a mean follow-up of 30.2 months (1-60). Long-term primary and secondary patencies were significantly different between TASC Cand TASC D lesions (P<.004 & .001). CONCLUSION: Severity of lesions, rather than preoperative symptoms or runoff, is mainly to be considered before using Hemobahn/Viabahn endoprosthesis in severe SFA occlusive lesions.     

Iliac artery stenting versus surgical reconstruction for TASC (TransAtlantic Inter-Society Consensus) type B and type C iliac lesions

OBJECTIVE: The TransAtlantic Inter-Society Consensus (TASC) document did not define the best treatment for moderately severe iliac artery lesions, ie, TASC type B and type C iliac lesions, because of insufficient solid evidence to make firm recommendations. The purpose of this study was to evaluate the influence of risk factors on outcome of iliac stenting and operative procedures used to treat TASC type B and type C lesions. METHODS: Over the 5 years from 1996 to 2001, 188 endovascular and direct aortoiliac surgical reconstruction procedures were performed in 87 women and 101 men with TASC type B and type C iliac lesions and chronic limb ischemia. The criteria prepared by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery (SVS/ISCVS) were followed to define variables. Both univariate analysis (Kaplan-Meier method) and multivariate analysis (Cox proportional hazards model) were used to determine the association between variables, cumulative patency rate, limb salvage, and survival. RESULTS: Indications for revascularization were disabling claudication (73%), limb salvage (25%), and blue toe syndrome (2%). Patients in the surgery group (n = 52) had significantly higher primary patency rates compared with patients in the stent group (n = 136) at univariate analysis (Kaplan-Meier method, log-rank test; P =.015). Primary patency rates at 1, 3, and 5 years were 85%, 72%, and 64% after iliac stenting, and 89%, 86%, and 86% after surgical reconstruction, respectively. Univariate and multivariate Cox regression analysis enabled identification of poor runoff (ie, runoff score >5 for unilateral procedures or >2.5 for bilateral outflow procedures; relative risk, 2.5; 95% confidence interval [CI], 1.4-4.2; P =.001) as the only independent predictor of decreased primary patency in all patients. However, stratified analysis including only patients with poor runoff revealed that patients undergoing iliac stenting had significantly lower primary patency rates compared with those undergoing surgical reconstruction (Kaplan-Meier method, log-rank test; P =.05). External iliac artery disease and female gender were also identified as independent predictors of decreased primary stent patency. CONCLUSIONS: Poor infrainguinal runoff is the main risk factor for decreased primary patency after surgical reconstruction and iliac stenting to treat TASC type B and type C iliac lesions. However, primary patency is less affected by poor runoff in patients undergoing surgical procedures. The presence of poor runoff, external iliac artery disease, and female gender are independent predictors of poor outcome after iliac stenting, and therefore these risk factors should determine the need for surgical reconstruction.     

Long-term outcomes and predictors of iliac angioplasty with selective stenting

OBJECTIVE: To review our 11-year experience of iliac angioplasty with selective stenting and to evaluate the safety, short- and long-term patency, clinical success rates, and predictive risk factors in patients with iliac artery occlusive disease. METHODS: From August 1993 to November 2004, 151 iliac lesions (149 stenoses, 2 occlusions) in 104 patients were treated by percutaneous transluminal angioplasty (PTA). The patients had chronic limb ischemia described as disabling claudication (the Society for Vascular Surgery clinical category 2 or 3) in 76 (50%), rest pain (category 4) in 38 (25%), and ulcer/gangrene (category 5) in 37 (25%). Forty-six limbs (30%) were treated with concomitant infrainguinal endovascular (36, 24%) or open procedures (10, 6%). Thirty-four limbs (23%) had one or more stents placed for primary PTA failure, including residual stenosis (> or =30%), mean pressure gradient (> or =5 mm Hg), or dissection (stent group); whereas, 117 limbs (77%) underwent PTA alone (PTA group). The affected arteries treated were 28 (19%) common iliac, 31 (20%) external iliac, and 92 (61%) both arteries. According to TransAtlantic Inter-Society Consensus (TASC) classification, 39 limbs (26%) were in type A, 71 (47%) in type B, 36 (24%) in type C, and 5 (3%) in type D. Reporting standards of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery were followed. RESULTS: There was no perioperative death. Total complication rate was 0.7% (one groin hematoma). The mean follow-up was 21 months (median, 10; range, 1 to 94 months). Only 9 (8%) of 117 of the PTA group had subsequent stent placement for recurrent stenosis. The iliac lesions were more severe and extensive in the stent group than those in the PTA group according to TASC classification (Mann-Whitney U test [M-W], P < .0001) and anatomic location (M-W, P = .0019). The technical success rate was 99%, and the initial clinical success rate was 99%. Overall, the cumulative primary patency rates at 1, 3, and 5 years were 76%, 59%, and 49% (Kaplan-Meier [K-M]). The cumulative assisted primary and secondary patency rates at 7 years were 98% and 99% (K-M). The mean number of subsequent iliac endovascular procedures was 1.4 per limb in patients with primary failure of iliac angioplasty/stenting. The continued clinical improvement rates at 1, 3, and 5 years were 81%, 67%, and 53% (K-M). The limb salvage rates at 7 year were 93% (K-M). Of 15 predictor variables studied in 151 iliac lesions, the significant independent predictors for adverse outcomes were smoking history (P = .0074), TASC type C/type D lesions (P = .0001), and stenotic ipsilateral superficial femoral artery (P = .0002) for the primary patency rates; chronic renal failure with hemodialysis (P = .014), ulcer/gangrene as an indication for PTA (P < .0001), and stenotic ipsilateral superficial femoral artery (P = .034) for the continued clinical improvement (K-M, log-rank test and Cox regression model). CONCLUSIONS: Although the primary patency rates were not high, the assisted primary and secondary patency rates were excellent without primary stenting. Overall, >70% of iliac lesions were treated successfully with PTA alone. The results of this study show that selective stenting offers satisfactory assisted primary and secondary long-term patency after iliac angioplasty. Patients with TASC type C/type D iliac lesions, a stenotic ipsilateral superficial femoral artery, ulcer/gangrene, smoking history, and chronic renal failure with hemodialysis should be followed carefully after endovascular iliac revascularization. These risk factors could be considered indications for primary stenting, although further studies are needed to confirm this.     

Efficacy of Hemobahn in the treatment of superficial femoral artery lesions in patients with acute or critical ischemia: a comparative study with claudicants.

PURPOSE: To assess the results of covered stents in the treatment of superficial femoral artery (SFA) occlusive disease. METHOD: From July 2000 till June 2003, 32 patients (34 limbs) were scheduled for procedures including Hemobahn deployment in the SFA. Indication for treatment was claudication (group I, N=15 patients and 16 limbs, 31.2% occlusions) or critical and acute ischemia (group II, N=17 patients and 18 limbs, 61.1% occlusions). TASC D SFA lesions were excluded. No limb artery was patent pre-operatively in 19% and 89% of limbs in groups I and II, respectively (p=0.00001). RESULTS: Outflow procedures were performed simultaneously in one limb in group I and 12 in group II (p=0.0003). The technical, hemodynamic and clinical success rates were 100, 100 and 94.1%, respectively. Mean follow-up was 18.1 months. Primary patency rates at 12 months were 81.3+/-10.6% in group I and 88.6+/-9.0% in group II (p=0.547). At 12 months, the secondary patency and limb salvage rates were, respectively, 87.5+/-8.9 and 100% in group I and 87.5+/-8.93 and 94.45+/-6.71% in group II. CONCLUSION: Treatment of SFA occlusive lesions (excluding TASC D lesions) with the Hemobahn covered stent yielded good results for both claudicants with good outflow and patients with critical or acute ischemia with bad outflow, if concomitant outflow-improving procedures were performed.     

血管腔内成形术治疗髂动脉硬化闭塞症

目的 探讨血管腔内成形术治疗髂动脉硬化闭塞症的临床疗效.方法 回顾性分析2002年12月至2008年12月收治的61例(76条血管)髂动脉硬化闭塞症患者的临床资料,其中男46例,女15例.平均年龄(67±11)岁.主要临床症状包括严重的间歇性跛行(跛行距离<100 m)38例,静息痛13例,肢/趾端溃疡10例.TASC A型病变29例,B型16例,C型11例,D型5例.应用导丝导管或超声消融开通闭塞段,行腔内支架置入术后随访.结果 61例患者71条血管成功开通(共置入63枚支架),开通率93%(71/76).成功者临床症状改善率100%.踝肱指数(ABI)由术前0.33±0.17提高到术后0.72±0.20,差异有统计学意义(P<0.05).随访51例,随访率83%.随访时间6-60个月,平均(26±14)个月.1年通畅率90%(TASC A、B组92%;TASC C、D组84%).3年通畅率75%(TASC A、B组80%;TASC C、D组63%);5年通畅率72%.结论 髂动脉硬化闭塞的腔内成形术较传统的血管重建手术创伤小、并发症低,近、中期通畅率相当.     

复合术式治疗复杂型下肢动脉硬化闭塞症疗效分析及其影响因素的研究

目的探讨复合术式(球囊扩张、支架植入联合内膜剥脱及取栓)治疗复杂型下肢动脉硬化闭塞症(ASO)的远期疗效及其相关影响因素。方法回顾性分析2005年1月至2009年11月间,复合术式(球囊扩张+支架置入、内膜剥脱+介入、导管取栓+介入)治疗318例ASO患者的临床资料,其中糖尿病性下肢动脉硬化闭塞症(DASO)198例(61例为双侧病变)259侧肢体,非糖尿病性下肢动脉硬化闭塞症(NDASO)120例(41例为双侧病变)161侧肢体。随访6～36个月,分析患者腘动脉以下血管及股浅动脉的通畅率及其相关影响因素。结果 318例患者中首次治疗成功率分别为DASO腘动脉以下血管90%,股浅动脉血管92%,NDASO腘动脉以下血管91%,股浅动脉血管94%,随访6～36个月,DASO腘动脉以下血管通畅率明显低于NDASO腘动脉以下血管通畅率。DASO腘动脉以下血管累积二次通畅率为89%～67%,股浅动脉血管累积二次通畅率为93%～73%。支架植入组的狭窄率显著低于非支架植入组(P0.05)。DASO的血管的通畅率减低与吸烟史、高血压、血糖控制不稳等因素有关。无围术期死亡及严重并发症发生。结论复合术式治疗下肢动脉硬化闭塞症适应范围广泛,疗法肯定。控制相关影响因素,可有效提高疗效。     

Thermal laser-assisted balloon angioplasty of the superficial femoral artery: a multicenter review of 602 cases.

A multicenter review of 602 procedures was performed to evaluate the effects of thermal laser-assisted balloon angioplasty on the superficial femoral artery. Four hundred thirty-nine (73%) patients underwent laser-assisted balloon angioplasty for claudication, and 163 (27%) underwent the procedure for limb salvage. Two hundred ninety-two laser-assisted balloon angioplasty procedures were performed for multifocal stenotic disease (greater than 80%) diameter reduction), 258 for total occlusion, and 52 procedures for both superficial femoral artery stenosis and occlusion. The initial recanalization rate was 89% (538/602) depending on the length of the lesion. Success of laser-assisted balloon angioplasty was verified by angioscopy or arteriography, and all patients underwent segmental Doppler studies before discharge and during midterm follow-up extending to 30 months (mean, 11.3 months). Complications occurred in 62 (10%) patients, but only one limb amputation occurred because of a complication related to a laser-assisted balloon angioplasty. Overall, 60% of initially successful procedures have remained patent, but long segment (greater than 7 cm) occlusions have fared poorly (25% patency at 30 months). This minimally invasive technology affords the opportunity to treat short segment (less than 7 cm) symptomatic superficial femoral artery occlusive disease with minimal risk. Initial success and midterm patency rates for appropriate lesions appear to make laser-assisted balloon angioplasty a viable adjunct in the treatment of superficial femoral artery occlusive disease.