糖尿病膝下动脉病变经皮腔内血管成形术的短期疗效

目的 评价糖尿病膝下动脉病变经皮腔内血管成形术(PTA)的临床短期疗效.方法 本组35例糖尿病合并缺血性下肢动脉病变患者,男20例,女15例,年龄50～81岁,中位年龄为69岁.Rutherford-Becker分级Ⅰ级6例,临床表现为中度以上间歇性跛行;Ⅱ级10例,临床表现为缺血性静息痛;Ⅲ级19例,为不同程度的溃疡和坏疽.所有患者术前均行患肢CT三维重建(CTA)及数字减影血管造影(DSA)检查,术后定期门诊随访,观察记录临床症状和体征变化,并测定1、3、6和12个月患肢踝肱指数(ABI).结果 35例患者53侧肢体共60支膝下动脉存在狭窄或闭塞,其中51支动脉通过球囊扩张得以开通,PTA成功率为85.0%.所有患者的疼痛症状均明显缓解,32例患者单位时间步行距离和固定距离步行时间均恢复正常.术后12个月ABI为0.65,与术前(0.49)的差异无统计学意义(P0.05).结论 PTA是治疗糖尿病膝下动脉病变安全有效的方法.

Percutaneous transluminalangioplasty in treatment of diabetic patients with infra-popliteal arterial diseases:analysis of the clinical efficacy

Objective To evaluate the short-term clinical effect of percutaneous transluminalangioplasty (PTA) in treatment of diabetic infra-popliteal arterial diseases. Methods Thirty-five diabetic patients with lower limb ischemic arterial diseases were recruited in the present research; the patients included 20 males and 15 females, with an average age 69 years old (ranging 50--81 years old). All the patients were graded based on the Rutherford-Becker Grading as follows: level Ⅰ in 6 cases with at least middle level intermittent claudication, level Ⅱ in 10 cases with ischemic rest pain, and level Ⅲ in 19 cases with lower limb skin ulcer and/or gangrene. Before treatment, the average Ankle-Brachium Index(ABI) was 0.49, ranging 0.2-0.6. All affected limbs were examined with three-dimensional reconstruction CT angiography (CTA) and digital subtraction angiography (DSA). Totally 53 limbs with 60 infra-popliteal arteries underwent PTA therapy. The changes of the clinical symptoms and the ABI assessment at 1,3, 6 and 12 months were followed up. Results Sixty arteries in 35 cases were selected for PTA. Fifty-one arterial branches of 33 cases were recanalized, with a technical success rate of 85.0%. All the 33 patients achieved clinical remission. Thirty-two cases regained normal walking distance in unit time and walking time in unit distance. The ABI was 0.65 at 12 months after the PTA, which was not significantly different from that before operation (P0.05). Conclusion PTA is a safe and effective method for treatment of diabetic infra-popliteal arterial diseases.