老年2型糖尿病下肢动脉硬化闭塞症的介入治疗

目的探讨老年2型糖尿病(T2DM)下肢动脉硬化闭塞症(ASO)介入治疗的临床价值。方法选取2009年1月至2013年6月成功行血管内介入治疗的132例老年T2DM下肢动脉硬化患者,采用腔内血管成形术(PTA)和置入血管支架进行介入治疗,部分病例术中病变血管内灌注尿激酶。结果本组132例患者成功行介入治疗,共置入金属支架209枚(129例)。观察术后1、3、6、12个月的皮肤温度、跛行距离、踝肱指数(ABI),与术前相比较,下肢缺血症状明显改善,ABI由治疗前0.29±0.15增加至0.78±0.16。随访6~18个月,平均11个月。结论介入治疗具有治疗创伤小、治疗后恢复快、治疗成功率高、并发症低、治疗后保肢率高等优点,近期疗效显著,可作为老年T2DM ASO的首选治疗方法。     

经皮腔内血管成形术与单纯药物治疗膝下动脉缺血临床疗效对比研究

目的比较经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)与单纯药物治疗膝下动脉缺血的临床疗效。方法选择膝下动脉缺血患者73例,分为PTA治疗组37例和药物治疗组36例,分别记录患者治疗前和治疗后1、3、6、12、18和24个月踝肱指数(ankle brachial index,ABI)、跛行距离、血管通畅情况、静息痛及截肢情况,进行统计学分析,采用Kaplan-Meier曲线分析再通率和免截肢情况。结果 PTA治疗组治疗后1~24个月随访ABI均高于药物治疗组,到24个月时ABI仍高于药物治疗组(0.640±0.238 vs 0.500±0.152,P=0.038);PTA治疗组患者1和3个月跛行距离、1~18个月的静息痛改善幅度较药物治疗组明显(P0.05,P0.01);2组患者的免截肢生存曲线相似(P_(logrank)=0.618)。结论对于静息痛明显、严重间歇性跛行、急需改善症状的患者,PTA治疗将会获益更大,症状改善更为明显。     

下肢动脉硬化闭塞症支架置入后服用盐酸沙格雷酯的疗效观察

目的:探讨盐酸沙格雷酯治疗下肢动脉硬化闭塞症(arteriosclerotic obliterans,ASO)支架置入术后患者的疗效。方法:2008年6月至2009年10月,共52例因ASO而行下肢动脉支架置入术的患者,共57条患肢,随机分成两组,治疗组(26例,29条患肢)给予盐酸沙格雷酯100mg/次,3次/d,口服,对照组(26例,28条患肢)给予胰激肽原酶肠溶片120U,3次/d,口服。治疗6个月后从患者症状、跛行距离(distance of claudication,DOC)、踝肱指数(ankle/brachial index,ABI)、经皮氧分压(transcutaneousoxygen pressure,TcPO2)、支架再狭窄率、药物不良反应等方面判断治疗效果。结果:和对照组相比,治疗组术前ABI、TcPO2及DOC差异无统计学意义(P>0.05);术后2 w ABI、TcPO2差异无统计学意义(P>0.05);术后6个月ABI差异无统计学意义(P>0.05),TcPO2及DOC均改善,差异有统计学意义(P<0.05);治疗组主观感觉症状改善者25例,出现支架再狭窄1例,对照组主观感觉改善者22例,支架再狭窄3例,两者差异无统计学意义(P>0.05);治疗组支架两组术后用药未见明显不良反应。结论:盐酸沙格雷酯用于ASO支架置入术后治疗效果明确,安全、方便,值得推广。     

经皮氧分压评估下肢动脉硬化闭塞症经皮血管腔内成形术疗效的研究

目的 通过比较下肢动脉硬化闭塞症(ASO)经皮血管腔内成形术(PTA)前后的经皮氧分压(TcPO2)、踝肱指数(ABI)、趾肱指数(TBI)的变化,评价TcPO2在评估下肢ASO患者PTA疗效的临床价值.方法 ASO患者101例,下肢ASO患肢111例,行PTA术后2～9 d复查TcPO2、ABI及TBI.根据有无T2...     

外周血管内支架置入治疗2型糖尿病足的疗效及预后分析

目的探讨2型糖尿病足患者采用外周血管支架置入治疗的临床疗效。方法将2017年1月-2019年7月治疗2型糖尿病足的78例患者随机分为两组,A组采用常规治疗,B组采用外周血管支架介入治疗,对比两组患者的临床治疗效果。结果两组患者治疗前ABI指数对比差异无统计学意义(P>0.05),B组治疗后ABI指数、治疗总有效率明显高于A组,并发症发生率明显低于A组,数据比较差异有统计学意义(P<0.05)。结论 2型糖尿病足患者采用外周血管支架置入治疗,能有效改善患者的踝肱指数,降低患者发生急性动脉闭塞、足坏疽、大截肢事件等并发症发生率,且疗效显著。     

球囊扩张成形术后支架植入治疗下肢动脉硬化闭塞症的疗效及并发症研究

目的探讨球囊扩张成形术与球囊扩张后支架植入术治疗下肢动脉硬化闭塞症(ASO)的临床疗效和安全性。方法前瞻性分析2019年3月至2020年9月我院收治的80例下肢动脉硬化闭塞症患者的临床资料,分别采用球囊扩张成形术(对照组40例)与球囊扩张后支架植入术(观察组40例)治疗,治疗后随访6个月,超声测量踝臂血压指数(ABI)、脉搏波传导速度(PWV),并评价总体临床疗效,观察不良反应发生率。结果观察组总有效率为97.5%,明显高于对照组80%(P0.05);观察组跛行距离长于对照组,ABI和PWV低于对照组(P0.05);两组不良反应发生率差异无统计学意义(P0.05)。结论球囊扩张后支架植入术可很好地改善ASO患者下肢功能,延长跛行距离,预防再狭窄,可在临床推广应用。     

糖尿病性和非糖尿病性下肢动脉硬化闭塞症患者的腔内治疗对比分析

目的探讨糖尿病性和非糖尿病性下肢动脉硬化闭塞症(ASO)行经皮血管内成形术(PTA)的疗效。方法回顾性分析行PTA治疗下肢ASO患者97例。观察糖尿病性ASO(糖尿病组)32例和非糖尿病性ASO(非糖尿病组)65例临床表现、合并症、病变位置、手术成功率、静息痛缓解率、渍疡愈合率、截肢率和踝肱指数变化等。结果所有患者中,围手术期死亡1例,总随访率87.6%。糖尿病组PTA成功率87.7%,置入支架16枚,随访中再次行PTA 4例,截肢5例。非糖尿病组PTA成功率96.1%,置入支架48枚,随访中再次行PTA 9例,截肢7例。54例静息痛患者,术后疼痛消失45例(83.3%),25例溃疡,术后愈合16例(64.0%)。结论 PTA治疗糖尿病性ASO和非糖尿病性效果满意,是一个理想的选择,尤其是对那些远端流出道不良的病例。     

糖尿病性和非糖尿病性下肢动脉硬化闭塞症患者的腔内治疗对比分析

目的探讨糖尿病性和非糖尿病性下肢动脉硬化闭塞症（AS0）行经皮血管内成形术（PTA）的疗效。方法回顾性分析100例2012年1月—2014年1月行PTA治疗的下肢ASO患者。统计分析糖尿病性ASO（糖尿病组）和非糖尿病性AS0（非糖尿病组）的临床表现、合并症、病变位置、手术成功率、静息痛缓解率、溃疡愈合率、截肢率和踝肱指数变化等。结果糖尿病组患者的PTA成功率为87.4%,置入38枚支架。在随访中,再次行4例PTA。非糖尿病组患者的PTA成功率为95.7%,置入42枚支架。在随访中,再次行9例PTA。在57例静息痛患者中,疼痛术后消失45例;27例溃疡,在术后愈合17例。结论在治疗糖尿病性和非糖尿病性的AS0患者,PTA的效果较为满意,是不错的治疗方式。     

糖尿病性和非糖尿病性下肢动脉硬化闭塞症患者的腔内治疗对比分析

目的探讨糖尿病性和非糖尿病性下肢动脉硬化闭塞症(AS0)行经皮血管内成形术(PTA)的疗效。方法回顾性分析100例2012年1月—2014年1月行PTA治疗的下肢ASO患者。统计分析糖尿病性ASO(糖尿病组)和非糖尿病性AS0(非糖尿病组)的临床表现、合并症、病变位置、手术成功率、静息痛缓解率、溃疡愈合率、截肢率和踝肱指数变化等。结果糖尿病组患者的PTA成功率为87.4%,置入38枚支架。在随访中,再次行4例PTA。非糖尿病组患者的PTA成功率为95.7%,置入42枚支架。在随访中,再次行9例PTA。在57例静息痛患者中,疼痛术后消失45例;27例溃疡,在术后愈合17例。结论在治疗糖尿病性和非糖尿病性的AS0患者,PTA的效果较为满意,是不错的治疗方式。     

多元思维让您“足”智多谋

糖尿病足是指糖尿病患者由于合并神经病变及各种不同程度末梢血管病变而导致下肢感染、溃疡形成和（或）深部组织的破坏。其临床特点为早期肢端麻木、疼痛、发凉和《或）有间歇性跛行、静息痛，继续发展则出现下肢远端皮肤变黑、组织溃烂、感染、坏疽。糖尿病足溃疡使患者生活质量严重下降，且治疗相当困难，治疗周期长，医疗费用高。本病属中医“筋疽”、“脱疽”等范畴。     

Effects of beraprost sodium (Dorner) in patients with diabetes mellitus complicated by chronic arterial obstruction

The effects of the prostaglandin I2 derivative beraprost sodium (Dorner) on ankle pressure index (AP; ankle joint-to-upper extremity systolic pressure ratio), subjective symptoms, and intermittent claudication were investigated in diabetic patients with arteriosclerosis obliterans (ASO). Forty patients (25 men and 15 women), mean age 63.9 years, were enrolled in this study. ASO was grade I in 30 patients, grade II in seven, grade III in one, and grade IV in two according to the Fontaine classification. They were administered six tablets (20 microg/tablet) of beraprost sodium daily for 6 months. At 3 and 6 months, API had significantly increased and symptoms such as coldness, numbness, and lack of feeling in the lower extremities were significantly improved. Ten evaluable patients increased ambulatory distance by approximately threefold, suggesting an improvement in intermittent claudication. Adverse reactions were experienced by five (12.5%) of the 40 patients (one case each of headache, dull headache, pain in the posterior region of the neck, heartburn, stomach discomfort, and anemia), but all were mild and resolved without treatment. Beraprost sodium was shown to improve API and symptoms in the lower extremities in diabetic patients with ASO, suggesting that it is useful in treating peripheral circulatory disorders in such patients.     

糖尿病足患者膝以下动脉的介入治疗

糖尿病足血管病变范围广,膝以下血管以重度乃至完全闭塞病变为主,介入治疗后患肢血流改善明显,皮温及踝肱指数明显升高,溃疡愈合加快,间歇性跛行距离显著增加,经股动脉穿刺介入治疗近期疗效满意,可明显改善患肢血供.     

Modifications in transcutaneous oxygen pressure in ischemic limbs after successful PTA

Foot and chest transcutaneous oxygen pressure (TcPO₂), the regional perfusion index (RPI = foot TcPO₂/chest TcPO₂), and the ankle/brachial systolic blood pressure index (ABI) were calculated before and after successful percutaneous transluminal angioplasty (PTA) in 36 limbs with intermittent claudication and in 8 with rest pain. In patients affected by intermittent claudication pain-free (PFWT) and maximum walking times (MWT) and the half-recovery time (HRT) to TcPO₂ basal values after an induced ischemia were also determined. After PTA, rest pain disappeared in the 8 severely ischemic lower limbs and significant differences were observed in the RPI, which increased by 215% from 0.19 ± 0.10 to 0.60 ± 0.13 (p<0.0001). In patients with intermittent claudication the RPI and the TcPO₂ HRT in particular improved significantly (p<0.0001) (RPI: from 0.68 ± 0.18 to 0.85 ± 0.20; HRT: from 120 ± 27 to 75 ± 37 s). These modifications were associated, in the 24 patients who performed a standard treadmill test, with the disappearance of claudication or with a significant improvement in their walking capacity. The ABI was not calculated in 12 limbs because the arteries could not be compressed but it significantly improved in the other limbs in the stage II peripheral arterial occlusions disease (PAOD) patients.These results indicate that substantial increases in TcPO₂ parameters can be observed after successful PTA and that these measurements are an appropriate noninvasive method of assessing the results of revascularization procedures.Presented at the 34th Annual Meeting, International College of Angiology, Budapest, Hungary, July 1992     

Correlation of arteriosclerosis obliterans of the lower extremity with coronary artery disease

To ascertain the correlation between arteriosclerosis obliterans (ASO) of the lower extremities and coronary artery disease (CAD), 69 patients with lower extremity ASO were observed. Based on clinical symptoms, the patients were categorized as group A: 52 with intermittent claudication and group B: 17 with angina pectoris. All patients underwent angiography of both lower extremities and the heart. Results were as follows: 1. In group A, 33 patients had significant coronary stenosis with single (16 cases), double (12 cases) and triple (five cases) vessel disease. Sixteen patients had histories of myocardial infarction and two had vasospastic angina. In group B, 15 patients had significant coronary stenosis with single (five cases), double (six cases) and triple (four cases) vessel disease including two cases involving the left main trunk. Six patients had histories of myocardial infarction and two had vasospastic angina. 2. Electrocardiography revealed that 37 patients in group A and 14 patients in group B had abnormal ECGs as abnormal Q waves and ST-T changes. However, 10 patients in group A and three patients in group B had significant coronary stenosis despite their normal ECGs. 3. According to the sites of stenotic lesions, all 69 patients with ASO were classified in four types; as diffuse, pelvic, ilio-femoral and femoral. The incidence of CAD did not differ among these four types. 4. In group A, 38 patients experienced revascularization of ASO; 36 cases by bypass grafting, and two by percutaneous transluminal angioplasty (PTA). Ten patients received cardiac revascularization including three cases with coronary artery bypass graft (CABG) and seven cases with percutaneous transluminal coronary angioplasty (PTCA). In group B, 13 patients received revascularization of ASO with bypass grafting. Eleven patients had coronary revascularization including seven cases with CABG and four cases with PTCA. 5. Fourteen of the 69 patients received revascularization for both ASO and CAD. In conclusion, there is a highly significant coincidence of CAD in patients with ASO, and CAD is often silent. These data indicate that routine coronary angiography is necessary for detecting and preventing CAD in all patients with ASO. Coronary artery revascularization, especially PTCA, can be indicated prior to lower extremity revascularization.     

Hybrid surgery techniques for the treatment of in-stent restenosis after 5 years of femoral artery self-expanding bare-metal stent implantation: A case report

Rationale:Lower extremity arteriosclerosis obliterans (ASO) disease is caused by the formation of atherosclerotic plaque in the femoral artery, which causes the stenosis and occlusion of lower legs, and then leads to chronic limb ischemia. Stent intervention is the most common treatment for ASO in the lower extremities, although there is a risk of overstretching or fracturing the stent, resulting in stent rupture. We provide a unique method for treating stent rupture.Patient concerns:A 79-year-old male presented with intermittent claudication of the left lower limb for 6 months. Five years ago, a stent was placed in the lower extremity femoral artery. According to the examination, the stent suffered a modest torsional fracture.Diagnosis:The case was diagnosed with lower extremity ASO.Interventions:We performed a combination of femoral endarterectomy and interventional surgery.Outcomes:Blood flow was restored after the hybrid operation has been used to treat arterial stenosis in the lower limbs.Conclusion:Integrating vascular interventional surgeries can shorten surgical procedures time and increase success rates.     

动脉硬化闭塞症膝下动脉血管腔内治疗的近远期疗效观察

目的:观察动脉硬化闭塞症膝下动脉病变经皮血管腔内治疗的疗效。方法:选取我科2006年10月至2009年10月期间,动脉硬化闭塞症膝下动脉病变经皮血管腔内治疗的117例患者,回顾性分析腔内治疗开通血管的成功率及术后随访资料。结果:117例患者(132条患肢)初次腔内治疗成功率为90.15%(119/132)。术后平均随访18个月(4～36个月)。血管再狭窄发生率分别为:6个月8.5%(10/117),12个月19.0%(22/116),18个月25.9%(30/116)。21例临床症状复发,再次腔内治疗成功率85.7%(18/21)。患者手术后间歇性跛行、静息痛、缺血性溃疡等临床症状均明显改善。结论:动脉硬化闭塞症膝下动脉腔内治疗手术成功率较高,临床效果满意,远期有一定的复发率,但可再次治疗。     

Fate of limbs with failed vascular reconstruction in Buerger's disease patients

We surveyed the recent condition of lower limbs with failed vascular reconstruction in patients with Buerger's disease. Forty-three patients (mean age: 41.2+/-8.7 years) received infrapopliteal vascular reconstruction at Nagoya University Hospital. Symptoms at the time of surgery were intermittent claudication in 11 patients, rest pain in 13 and ulcer/gangrene in 19. Inquiry about the condition of the lower limbs was made during March 1998. Eight patients were lost to follow-up and three patients had died. In the remaining 32 patients, mean follow-up period was 140.5+/-42.0 months. Graft was occluded within a week after surgery in six patients with ischemic ulcer/gangrene, three of whom underwent a major amputation while the trophic lesion healed in the remaining three patients. Two grafts were occluded among the 11 patients with intermittent claudication. One of these patients had mild rest pain and the other reported intermittent claudication. Two of the patients with intermittent claudication were lost to follow-up. Among the 13 patients with rest pain, one had died and six were lost-to-follow-up. Although the remaining six patients complained of intermittent claudication, half had an occluded graft. Of the 19 patients with ulcer/gangrene, two had died and all nine of those with occluded graft complained of intermittent claudication. Fate of limbs with failed vascular reconstruction was satisfactory.     

大动脉炎合并肺动脉高压患者的临床分析

目的 分析大动脉炎(TA)合并肺动脉高压(PAH)的临床特点,以提高临床早期诊治的水平.方法 1987-2007年北京协和医院住院治疗的TA患者共191例,对其中合并PAH的12例患者的临床表现、实验窒检查及治疗、预后进行回顾性分析.结果 12例患者中女性10例,男性2例.年龄14～47岁,平均(27±10)岁.11例有肺血管受累的临床表现和(或)体征,7例以肺血管受累表现(活动后气短、咯血)为首发症状,其他首发表现分别为发热4例,乏力4例,四肢缺血表现(下肢间歇性跛行、上肢痛、肢体麻木)4例,头晕3例.12例患者中7例为Ⅰ+Ⅳ型、1例为Ⅱ+Ⅳ型、3例为Ⅲ+Ⅳ型、1例为Ⅳ型.10例患者有炎性指标[红细胞沉降率(ESR)、C反应蛋白(CRP)]明显升高,ESR(66±56)mm/1 h.所有的患者均接受激素及免疫抑制剂治疗,1例行支架植入术,1例接受手术治疗.除1例因术后低心排出量死亡外,其余患者症状均好转.结论 PAH为大动脉炎累及肺血管的晚期及严重并发症,常合并有全身其他部位血管受累.早期因起病隐匿不易引起重视,应行肺血管造影、CTA或心脏超声进行早期筛查,早期治疗.治疗上除激素、免疫抑制剂治疗原发病外,当血管重度狭窄时可行支架植入或血管扩张术.     

下肢严重毁损伤保肢治疗体会

目的总结10例下肢严重毁损伤保肢治疗的过程和经验。方法回顾性分析2018-06~2019-05收治的10例下肢严重毁损伤患者的临床资料。所有患者在受伤后2~10 h内行清创缝合、外固定支架固定、血管神经肌腱吻合术、负压封闭引流(vacuum sealing drainage,VSD)治疗术等综合治疗。结果7例患者患肢保全,其中5例能自行下地行走,功能评价满意,另2例术后功能恢复较差,行走跛行伴疼痛明显。2例患者因缺血性坏死伴感染,二期行大腿下段清创截肢术。1例因下肢毁损伤严重,术中即行下肢残端修整术。结论正确评估下肢毁损伤程度,合理制定手术方案,能够增加保全肢体有效性,降低致残率,减轻患者心理与经济负担。