DSA引导下血管腔内成形术治疗下肢动脉硬化闭塞症的临床研究

目的:探讨DSA引导下血管腔内成形术(TA)治疗下肢动脉硬化闭塞症(ASO-LE)的临床效果。方法:2017年3月至2019年4月,手术治疗的ASO-LE患者93例,依据治疗方式的不同分为A组(行TA,n=49)和B组行下肢动脉旁路移植术(LEABG),n=44],两组患者均在数字减影血管造影(DSA)引导下进行。对比两组患者手术成功率;两组患者术前即刻(T1)、术后1 d(T2)、术后3 d(T3)及术后1周(T4)时刻视觉模拟疼痛评分(VAS);对比术前(T1')、术后1个月(T2')及术后3个月(T3')时刻两组患者下肢缺血程度患者踝肱指数(ABI)、趾肱指数(TBI)];对比T1'、T2'及T3'时刻两组患者足背动脉血流动力学足背动脉内径(D)、血流峰速(PV)、血流量(BF)];对比T1'、T2'及T3'时刻两组患者下肢感觉神经传导速度(SNCV)和运动神经传导速度(MNCV);术后6个月,对比两组患者并发症发生率。结果:两组患者手术成功率无显著差异(P>0.05);患者VAS评分组间、时间、交互对比差异均有统计学意义(P<0.05),与T1相比,T2、T3及T4时两组患者VAS评分均降低(P<0.05),与T2相比较,T3及T4时两组患者VAS评分均降低(P<0.05),与T3相比较,T4时两组患者VAS评分均降低(P<0.05),A组T2、T3及T4时刻VAS评分均低于B组(P<0.05);ABI、TBI、D、PV、BF、SNCV和MNCV组间、时间、交互对比差异均有统计学意义(P<0.05);与T1'相比,T2'及T3'时两组患者ABI、TBI、D、PV、BF、SNCV和MNCV均升高(P<0.05);与T2'相比较,T3'时2组患者ABI、TBI、下肢SNCV和MNCV均升高(P<0.05),A组T2'及T3'时刻ABI、TBI、D、PV、BF、SNCV和MNCV均高于B组(P<0.05);A组患者并发症发生率显著低于B组(P<0.05)。结论:相比LEABG,DSA引导下对ASO-LE患者进行TA治疗能够减轻疼痛,改善下肢缺血及足背动脉血流动力学,提高下肢SNCV和MNCV,降低并发症的发生率。

DSA guided angioplasty in the treatment of lower extremity arteriosclerosis obliterans

Objective:To investigate the clinical study of DSA guided angioplasty in the treatment of arteriosclerosis obliterans(ASO-LE).Methods:A retrospective analysis of 93 ASO-LE patients who received surgical treatment in our hospital from March 2017 to April 2019,according to the different treatment methods,the patients were divided into group A(transluminal angioplasty,n=49)and group B(bypass grafting of lower extremity artery,n=44).The patients in both groups were guided by digital subtraction angiography(DSA).Comparison of the success rate of operation between the two groups.The visual analogue pain score(VAS)was compared between the two groups immediately before operation(T1),one day after operation(T2),three days after operation(T3)and one week after operation(T4).The degree of lower limb ischemiaankle brachial index(ABI),toe brachial index(TBI)]in two groups was compared before operation(T1'),1 month after operation(T2')and 3 months after operation(T3').The hemodynamicsdiameter(D),peak velocity(PV)and blood flow(BF)]of dorsalis pedis artery were compared between the two groups at T1',T2'and T3'time.Comparison of sensory nerve conduction velocity(SNCV)and motor nerve conduction velocity(MNCV)of lower limbs between two groups at T1',T2'and T3'time.The incidence of complications was compared between the two groups at 6 months after operation.Results:There was no significant difference between the two groups(P>0.05).There were significant differences in VAS scores among groups,time and interaction(P<0.05).Compared with T1,the VAS scores of T2,T3 and T4 groups were lower(P<0.05).Compared with T2,T3 and T4,the VAS scores of T3 and T4 groups were lower(P<0.05).Compared with T3,the VAS scores of T4 groups were lower(P<0.05).The VAS scores of T2,T3 and T4 in group A were lower than those of group B(P<0.05).There were significant differences in ABI,TBI,D,PV,BF,SNCV and MNCV of lower limbs among the groups,time and interaction(P<0.05).Compared with T1',ABI,TBI,D,PV,BF,SNCV and MNCV of lower limbs were increased at T2'and T3'in both groups(P<0.05).Compared with T2',the ABI,TBI,SNCV and MNCV of lower limbs were increased at T3'in both groups(P<0.05),ABI,TBI,D,PV,BF,SNCV and MNCV of lower extremity in group A at T2'and T3'were higher than those in group B(P<0.05).The incidence of complications in group A was significantly lower than that in group B(P<0.05).Conclusion:Compared with lower extremity artery bypass grafting,DSA guided intravascular angioplasty for ASO-LE patients can reduce pain,improve lower extremity ischemia and hemodynamics of dorsalis pedis artery,improve lower extremity SNCV and MNCV,and reduce the incidence of complications.