介入放射学诊治糖尿病性外周动脉病变的价值

数字减影血管造影(DSA)是诊断糖尿病外周动脉病变的金标准。糖尿病与非糖尿病的闭塞性动脉硬化性外周动脉病变在血管分布和不同血管的病变程度上有着明显区别。病变血管的积分评价有助于治疗方法的选择和预后判断。糖尿病外周动脉病变应早期诊断、早期干预,以降低截肢率。外周血管病变的介入治疗具有较好的近、远期效果。     

股深动脉重建治疗下肢动脉硬化闭塞症的临床经验

我科2004年6月～2008年6月采用人工血管旁路转流术、股深动脉成形术等方法恢复股深动脉血流,治疗Fontaine Ⅲ、Ⅳ期下肢动脉硬化闭塞症患者41例.     

股深动脉成形术治疗下肢动脉硬化闭塞症5例

下肢动脉硬化闭塞症目前尚无特效治疗方法。1990年6月至今,我们对5例下肢动脉硬化闭塞症患者施行了股深动脉成形术,效果良好。现报告如下。     

中老年糖尿病患者下肢动脉病变与代谢异常的特点

目的分析糖尿病足病患者下肢动脉粥样硬化病变与代谢异常的关系。方法选择2型糖尿病患者362例,男性232例,女性130例,平均年龄(64.9±11.2)岁,平均糖尿病病程(9.2±7.5)年。通过动脉超声检查下肢股动脉、腘动脉和胫动脉病变情况,按照动脉病变程度将患者分为4组:对照组、斑块组、狭窄组(≥50%)和闭塞组。所有患者测定空腹血糖、糖化血红蛋白(GhbAlc)和血脂谱(总胆固醇、甘油三酯、低密度脂蛋白和高密度脂蛋白)等。结果 (1)斑块组和狭窄组患者GHbAlc 水平分别为(8.4±2.2)%和(8.7±2.1)%,与对照组(7.9+2.1)%比较,差异有统计学意义(P<0.05),狭窄组胆固醇和甘油三酯水平均比斑块组高(P<0.05和 P<0.01);(2)斑块组和狭窄组患者高血压、冠心病、眼底病变以及肾脏病变患病率显著高于对照组和闭塞组(P<0.05);(3)股动脉和腘动脉斑块病变患病率为77.8%和73.3%,高于胫动脉62.1%(P<0.01)。狭窄和闭塞病变主要发生在胫动脉,分别为29.1%和6.1%。结论中老年糖尿病患者股动脉、腘动脉和胫动脉斑块病变较常见,且动脉病变与代谢异常相关,应给予积极的干预治疗。     

髂动脉支架联合股深动脉成形术治疗下肢动脉硬化闭塞症12例回顾性分析

下肢多平面多节段动脉硬化闭塞是老年人下肢缺血的主要原因，经典的动脉旁路术是有效的治疗手段，但是对于远端流出道不佳或伴有严重心脑肺肾等重要脏器功能不全的老年病人，不适合行创伤较大的动脉旁路手术治疗，部分病人因而丧失治疗机会而被截肢，严重影响了老年人的生活质量。随着血管腔内介入治疗技术的巨大进步，腔内介入治疗与腔外手术相结合已成为新的研究发展方向。我院于2003年7月至2005年11月，应用术中髂动脉球囊扩张和支架植入结合股深动脉成形术治疗高危重症老年人下肢多平面动脉硬化闭塞症12例，现将回顾性分析结果报道如下。     

糖尿病下肢动脉病变危险因素分析

糖尿病下肢血管病变是最为常见的糖尿病大血管病变之一，它可导致糖尿病足乃至引起坏疽截肢。因此预防与减少糖尿病下肢血管病变显得极为重要。本文着重讨论糖尿病下肢动脉血管病变的相关因素，其中搜集了2000年1月至2003年1月在我院住院的34例糖尿病人进行分析。     

髂动脉至股深动脉腔内成形术治疗下肢动脉硬化闭塞症患者效果及并发症

<正>下肢动脉硬化闭塞症(LEASD)是一种以下肢麻木、发冷、疼痛、间歇性跛行为主要表现的退行性病变,其也是导致老年人下肢缺血的主要原因,若得不到及时、有效的治疗,很容易引起残疾甚至截肢〔1〕。LEASD是因动脉内形成粥样硬化斑块而引起的下肢动脉狭窄、阻塞,好发于小腿动脉、股浅动脉、髂动脉等〔2〕。开放性手术逐渐被血管腔内修复手术所替代,介入治疗已成为了目前临床治疗LEASD的主要手段。本文分析髂动     

髂动脉—股深动脉腔内重建治疗下肢动脉硬化闭塞伴严重缺血11例

目的 观察髂动脉—股深动脉腔内重建治疗下肢动脉硬化闭塞伴严重缺血的疗效.方法 下肢动脉硬化闭塞症伴严重缺血患者11例,均行髂动脉—股深动脉腔内重建治疗,观察手术成功率、临床治疗有效率、ABI值、截肢情况、并发症情况.结果 手术成功率与临床治疗有效率均为100％.所有患者坏死组织均转为干性.与术前比较,术后即刻、1个...     

股深动脉重建改善下肢动脉硬化闭塞症患者下肢缺血的疗效

目的 探讨股深动脉重建改善下肢动脉缺血方面的疗效.方法 根据CTA及血管彩超选择高危重症多节段动脉硬化闭塞症病例,对30例FontaineⅢ、Ⅳ期下肢动脉硬化闭塞症患者实施股深动脉重建.其中解剖外途径股-股深动脉人工血管转流术7例,髂总、髂外动脉-股深动脉人工血管转流术9例,髂动脉球囊扩张+支架植入术结合股深动脉成形术4例,腋动脉-股深动脉转流2例,单纯股深动脉成形术8例.结果 26例患者症状明显改善,皮温明显升高,静息痛消失,ABI明显升高(术前平均为0.23,术后平均为0.57).3例症状减轻,1例无效截肢.术后随访3～23个月(平均13个月).18例行人工血管转流术的病例中1例发生闭塞,人工血管通畅率为94.4％.8例单纯股深动脉成形的病例中1例闭塞.总体保肢率为96.7％.结论 在股浅动脉广泛闭塞时,股深动脉重建治疗Ⅲ、Ⅳ期动脉硬化闭塞症具有重要意义.     

老年2型糖尿病性下肢动脉病变的腔内治疗

目的 观察并总结腔内治疗老年2型糖尿病严重下肢动脉病变的临床疗效及技术经验.方法 收集2010年2月-2012年2月55例老年2型糖尿病性下肢动脉疾病患者,采用INVATEC-DEEP长球囊,进行下肢动脉经皮穿刺血管腔内成形术（percutaneous transluminal angioplasty,PTA）治疗,观察治疗前后的临床症状、体征及踝肱指数（ankle brachial index,ABI）的改变,并进行随访.结果 55例患者共55条肢体接受了腔内治疗,技术成功率为74.5％（41/55）,无并发症发生.共随访6m,失访率为0;其中,技术成功组所有患肢血供明显增加,相应节段肢体皮温升高,足背动脉搏动增强,麻木感和痛感显著减轻,生存率为95.1％,肢体存活率97.6％;技术失败组患者生存率为78.6％,肢体存活率71.4％,随访期间ABI为（0.78±0.13）.结论 腔内治疗老年2型糖尿病性下肢动脉疾病技术成功率高,临床疗效显著,但远期效果有待进一步随访.     

糖尿病性膝以下动脉病变血管造影分析

目的研究糖尿病性膝以下动脉病变数字减影血管造影（DSA）影像学的血流分级、病变分型。方法2型糖尿病患者107例的211条肢体成功行DSA检查。根据小腿动脉主干血流连续性和侧支形成将动脉血流分为0、1、2、3、4级;以Fontaine分级表示患肢缺血性临床症状;根据小腿动脉病变程度和累及血管的不同组合,将患肢病变表现分为A、B、C、D四种类型。结果208条肢体血流分级与Fontaine分级存在负相关（r=-0．438,P〈0．01）;Fontaine分级与病变分型基本相吻合,但Ⅱ、Ⅲ两级间差异无统计学意义;按A、B、C、D分型顺序,血流分级有逐渐降低趋势（P〈0．01）。结论综合病变类型和血流分级,可以较规范地描述膝以下各动脉主干病变程度和各支动脉病变不同组合,以及血管血流和侧支形成状况。     

糖尿病与非糖尿病患者外周动脉病变血管造影对比研究

目的　比较糖尿病和非糖尿病患者外周动脉病变的分布及其严重程度。　方法　 2型糖尿病 (T2DM)患者 (DM组 ) 4 3例 ,非糖尿病动脉硬化症患者 (NDM组 ) 39例。将造影动脉所见分为腹主、髂总、髂内、髂外、股深、股浅、、胫前、胫后和腓动脉共 10段 ,用分段积分法进行动脉管腔狭窄程度比较。　结果　腹主、腹部内脏、股深及胫前动脉病变发生率在NDM组分别为 33/ 34(97% )、11/ 30 (37% )、11/ 6 9(16 % )和 2 5 / 4 2 (6 0 % ) ,在T2DM组分别为 2 6 / 36 (72 % )、1/ 36 (3% )、2 4 / 78(31% )和 6 1/ 75 (81% ) ;NDM组腹主动脉积分为 0 2 6± 0 6 7、髂总动脉积分为 0 5 5± 1 0 6、髂内动脉积分为 1 0 8± 1 2 9;T2DM组相应的动脉积分分别为 0、0 15± 0 5 8和 0 5 7± 1 0 5 ;这些差异均有显著意义。T2DM组股深、、胫前、胫后、腓动脉积分分别为 0 6 0± 0 6 1、1 15± 0 82、1 92± 1 39、1 72± 1 85和 1 99± 1 0 5 ,均明显高于NDM组的 0 17± 0 4 8、0 75± 1 2 2、0 81± 0 94、1 0 7±1 0 0和 0 98± 1 0 0。　结论　NDM组较T2DM组血管病变更常累及腹主动脉及腹部内脏动脉 ,T2DM组较NDM组更常累及股深动脉和胫前动脉 ,且病变程度严重     

Association of borderline ankle-brachial index with mortality and the incidence of peripheral artery disease in diabetic patients

Objective

Peripheral artery disease (PAD) and diabetes mellitus are significant risk factors for all-cause death or cardiovascular death. PAD occurs more frequently in diabetic than in non-diabetic patients. However, the association of ankle-brachial index (ABI), especially borderline ABI, with clinical outcomes has not been fully elucidated in diabetic patients. This study aimed to investigate the association of ABI with mortality and the incidence of PAD in Japanese diabetic patients.

Methods

This observational study included 3981 diabetic patients (61.0 ± 11.8 years of age, 59.4% men), registered in the Kyushu Prevention Study for Atherosclerosis. Patients were divided into 3 groups according to the value of ABI at baseline: ABI ≤0.90 (abnormal ABI:354 patients), 0.91 ≤ ABI ≤ 0.99 (borderline ABI:333 patients), and 1.00 ≤ ABI ≤ 1.40 (normal ABI:3294 patients).

Results

Cumulative incidence of all-cause death was significantly higher in patients with abnormal and borderline ABI than in those with normal ABI (34.4% vs. 13.5%, P < 0.0001 and 26.1% vs. 13.5%, P < 0.0001, respectively). In multivariate analysis, the risks for all-cause death in patients with abnormal ABI (HR:2.16; 95%CI:1.46–3.14; P = 0.0002) and borderline ABI (HR:1.78; 95%CI:1.14–2.70; P = 0.01) were significantly higher than in those with normal ABI. The incidence of PAD was remarkably higher in patients with borderline ABI than in those with normal ABI (32.2% vs.9.6%, P < 0.0001). After adjustment, the risk for PAD was significantly higher in patients with borderline ABI than in those with normal ABI (HR:3.10; 95%CI:1.90–4.95; P < 0.0001).

Conclusions

Borderline ABI in diabetic patients was associated with significantly higher risks for mortality and PAD compared with normal ABI.     

Angiographic characteristics of the coronary artery in patients with type 2 diabetes

OBJECTIVES:

To investigate the adverse effect of type 2 diabetes on coronary artery anatomy.

PATIENTS AND METHODS:

The coronary angiograms of 1564 consecutive patients were analyzed. The coronary lesions of patients with and without type 2 diabetes were compared.

RESULTS:

Seventy-four diabetic and 824 nondiabetic patients were found to have coronary artery disease. Diabetic patients had more multivessel (48.7% versus 34.7%, P<0.01), multilesion (64.9% versus 46.1%, P<0.05), extensive (51.4% versus 7.8%, P<0.01) and small vessel disease (95.2% versus 39.8%, P<0.01) than nondiabetic patients.

CONCLUSIONS:

Type 2 diabetes is a significant risk factor for coronary artery disease. These findings may provide useful information for the future development of therapeutic strategies.     

和肽素和白介素在2型糖尿病患者无症状冠心病中的作用

目的探讨和肽素、白介素（IL-2、IL-4、IL-10）与2型糖尿病无症状冠心病患者的关系。方法选择213例冠状动脉（冠脉）连续造影证实至少一支血管狭窄≥70％的2型糖尿病患者,其中无典型心绞痛史61例（为无症状组）,稳定性心绞痛或急性冠脉综合征102例（为症状组）。另选择50例单纯糖尿病患者作为对照组。用放射免疫和ELISA方法测定血清和肽素、白介素和可溶性糖基化终末产物受体（esRAGE）浓度。结果与症状组比较,无症状组和肽素增高,IL-10和esRAGE减低,但三组间IL-2和IL4比较无明显差异。进一步分析显示,症状组中急性冠脉综合征患者较稳定性心绞痛IL-2、IL4、IL-10增高（P〈0．05）,和肽素减低。随冠脉病变血管支数增加,IL-10增高、esRAGE减低,但和肽素无显著变化。无症状组患者糖尿病病程较长。结论和肽素及IL-10在2型糖尿病患者无症状冠心病发病中具有重要作用。     

Silent myocardial ischemia in diabetic and nondiabetic patients with coronary artery disease

Background: Patients with diabetes mellitus are at increased risk for CAD; silent ischemia is reported to be frequent in diabetic populations. The aim of the present study was to evaluate the prevalence of silent ischemia in diabetic and nondiabetic patients with assessed CAD. Methods and results: We recruited a total of 618 patients with CAD: 309 were consecutive diabetic patients and 309 were age- and gender-matched nondiabetic patients. Myocardial ischemia was evaluated both during daily life and during exercise testing. Angina pectoris during daily life was more frequent in diabetic than in nondiabetic patients (80% vs. 74%, P<0.05). The anginal pain intensity either during daily life or acute myocardial infarction (MI), the prevalence of a previous MI, the extent of CAD and ergometric parameters were similar in diabetics and nondiabetics. Silent ischemia during exercise was documented in 179 (58%) diabetics and in 197 (64%) nondiabetics (nonsignificant, ns). Both diabetics and nondiabetics with silent exertional myocardial ischemia differed from symptomatic subjects in higher heart rate values (P<0.01), systolic blood pressure (P<0.01), rate–pressure product (P<0.001), work load (P<0.01) and maximum ST-segment depression at peak exercise (P<0.05). Conclusions: The incidence of silent myocardial ischemia during exercise was similar in diabetic and nondiabetic CAD patients. Surprisingly, diabetics showed a higher prevalence of angina pectoris during daily activity than nondiabetics. A significant association between the presence of symptoms during daily life and exercise was observed in both groups. Our results may contribute to the planning of the clinical management of diabetic CAD patients and confirm the individual attitude to pain of CAD patients independent of the presence of diabetes.     

Segmental blood flow and rheological determinants in diabetic patients with peripheral occlusive arterial disease

Vascular abnormalities are more prevalent in the lower extremities in diabetic patients and may cause diminished perfusion to surrounding tissues. We sought to identify blood flow abnormalities in the leg of diabetic patients with peripheral occlusive arterial disease (POAD) and to determine whether these were associated with abnormalities in rheological determinants, namely, plasma fibrinogen concentration (PFC), relative plasma viscosity (RPV), hematocrit (Hct), and whole blood viscosity (WBV). Seventeen diabetic patients with POAD were compared with 40 diabetic patients without POAD and 19 nondiabetic control subjects. Blood flow was measured by venous occlusion plethysmography, RPV was measured by capillary viscometry, WBV was measured by a Wells–Brooksfield viscometer [at high (230 s⁻¹) and low (23 s⁻¹) shear rates], and PFC was measured by the clot–weight method of Ingram [Ingram, G. I. C. (1961). A suggested schedule for the rapid investigation of acute haemostatic failure. Journal of Clinical Pathology, 14, 356–360]. Ankle blood flow (Q_ak) was significantly lower in diabetic patients with POAD than in diabetic patients without POAD (P<.05). PFC was higher and Hct was lower in diabetic patients with POAD than in diabetic patients without POAD (P<.05). RPV was 1.97±0.15 versus 1.92±0.15 in diabetic patients with POAD and diabetic patients without POAD, respectively (P>.05). There was no significant difference in WBV at low or high shear rates between the groups studied. There was a correlation between WBV at low shear rate and arterial flow in the calf (Q_c) (r=.94) and great toe (r=.95) in diabetic patients with POAD, and between Q_c and WBV at high (r=−.465) and low (r=−.472) shear rates in diabetic patients without POAD (P<.05). We conclude that vasodilatation occurring in diabetic patients without POAD is severely restricted or absent in diabetic patients with POAD. Increased plasma fibrinogen and plasma viscosity may contribute to this phenomenon.     

冠心病合并2型糖尿病患者临床及血运重建特点分析

目的 分析冠心病合并2型糖尿病患者的临床和血运重建特点.方法 以2011年9月至2012年4月于天津市胸科医院心内科住院,并行冠状动脉造影确诊为冠心病的215例患者作为观察对象,分为2型糖尿病组77例和非糖尿病组138例,分析临床和冠状动脉血运重建特点.结果 与非糖尿病组比较:(1)2型糖尿病组合并高血压的患者比例较高(87.0％比74.6％,P＜0.05),三酰甘油水平较高[(2.03 ± 1.22) mmol/L比(1.65±0.78) mmol/L,P＜0.01],左心室射血分数较低(58.03％±9.80％比61.07％±7.35％,P＜0.05);(2)2型糖尿病组单支病变发生率低(16.9％比43.5％,P＜0.01),多支病变发生率高(39.0％比25.4％,P＜0.05);(3)两组患者血运重建策略差异有统计学意义,2型糖尿病组患者行冠状动脉旁路移植术者比例较高(17.2％比7.3％,P＜0.05),选择行经皮冠状动脉介入治疗者平均置入支架数目较多[(2.06±0.95)枚比(1.66±0.83)枚,P＜0.01].结论 冠心病合并2型糖尿病患者高血压及血脂异常的发生率高,冠状动脉病变严重且弥漫,血运重建方式更复杂.     

前列地尔注射液治疗2型糖尿病并发下肢动脉闭塞症的临床研究——多中心、随机、双盲、阳性药平行对照研究

以前列地尔注射液凯时(北京泰德制药有限公司生产)为阳性对照药物,评价前列地尔注射液(陕西正康医药化工有限公司生产)治疗2型糖尿病合并的下肢动脉闭塞症的疗效,发现两种药物在改善患者步行距离、减轻下肢疼痛和提高ABI方面均有良好的治疗效果,两组间疗效差异无统计学意义(均P>0.05).     

Bare nitinol stent enabled recanalization of long-segment, chronic total occlusion of superficial femoral and adjacent proximal popliteal artery in diabetic patients presenting with critical limb ischemia

PurposeTo evaluate our experience of limb salvage with bare nitinol stent enabled recanalization of long length occlusions of superficial femoral artery (SFA) and adjacent proximal popliteal artery (PPA) in diabetic patients.MethodsA total of 573 patients underwent 842 lower limb interventions from August 2006 to September 2008 at our institute. A retrospective review was done of diabetic patients undergoing recanalization of long length SFA/adjacent PPA (>10 cm) occlusions with self expanding bare nitinol stents evaluating their impact on limb salvage.ResultsForty-four patients (mean age 65.2 years, M:F 25:19) underwent 49 long-length (>10 cm) SFA/PPA stenting procedures over a period of 26 months. Diabetics comprised 66% of patients (n=29, mean age: 63.7 years, M: F 19:10). The infrapopliteal distal run-off in this diabetic subgroup comprised one vessel (n=14/29, 48%), two vessels (n=12/29, 41%), and three vessels (n=3/29, 10%). The spectrum of critical limb ischemia included rest pain (n=8), ulcer (n=7) and gangrene (n=14). The lengths of occlusions recanalized were 10–39 cm. A total of 58 stents (individual length 10–17 cm, average diameter 6 mm, mean 2 stents per patient) were placed with average length of stented segment being 23.8 cm. Four patients had stents placed through ipsilateral popliteal artery approach with rest placed through femoral artery approach. Significant complications of the procedure included distal embolization (n=3) successfully managed with thrombolysis and popliteal arteriovenous fistula in one patient undergoing recanalization through popliteal approach, managed with covered stent placement. No procedure related mortality occurred during thirty-day follow-up period. All were followed up over an average duration of twelve months post-procedure. Three patients died due to associated medical conditions during this period. The following amputations were done on follow-up (three toe amputations, five forefoot amputations, three below-knee amputations, two above-knee amputations). The overall limb salvage rate was 80%.ConclusionOur study shows beneficial result of SFA/PPA stent placement in diabetic occlusions with significant concomitant infrapopliteal disease.