内膜下血管成形术治疗下肢动脉硬化闭塞患者的临床评价

目的 评价内膜下血管成形术（SIA）治疗下肢动脉硬化闭塞症的技术可行性和近期临床效果。方法 从2003年12月至2005年12月2年期间,应用内膜下血管成形术治疗36条下肢动脉硬化闭塞的患肢,动脉闭塞的平均长度为11．5cm（4．5～28．0cm）,其中13条肢体为生活方式受限性间歇性跛行,23条肢体为威胁肢体生存的严重性缺血。分析评价的主要参数为,内膜下血管成形术的技术成功率,再管化通道的通畅率,临床有效率和并发症。结果 内膜下血管成形术的技术成功率为80％,技术失败的7条肢体有4条成功地进行了血管旁路手术。平均随访13．2个月,再管化通道的通畅率为70％,临床有效率为81％,无严重的相关并发症发生。结论 SIA是治疗下肢动脉粥样硬化闭塞一种较好的可供选择的治疗手段,技术成功率高,近期效果尚满意。但SIA术后长期效果目前尚缺乏可信服的临床资料。

The clinical values of subintimal angioplasty for treatment lower extremity arterial occlusions

OBJECTIVE: The purpose of this study was to assess the technical feasibility and early outcomes of subintimal angioplasty to treat lower extremity arterial occlusions. METHODS: During a 2-year period (from December 2003 to December 2005), 36 lower extremities with arterial occlusions (median length, 11.5 cm; range, 4.5 to 28.0 cm) were treated on an intention-to-treat basis with SIA. Thirteen lower extremities had disabling claudication and twenty-three had limb-threatening ischemia. Main outcome measures: technical success, cumulative patency, clinical results and complications. RESULTS: The technical success rate was 80% and four out of seven failures were treated by conventional surgery. After 13.2 months follow-up, recanalization vessel patency rate was 70%, and clinical effectiveness rate was 81%, no serious complications occurred. CONCLUSION: In a selected group of patients, SIA is feasible with a high initial technical success rate and the short-term results are satisfied, SIA is a good treatment alternative in patients who are lower extremity arterial occlusions. The durability of this method of therapy is unknown, and our length of follow-up is not sufficient to answer this question.