介入治疗下肢动脉缺血性疾病的中长期疗效分析

【目的】探讨介入治疗下肢动脉缺血性疾病的中长期疗效。【方法】选择下肢动脉缺血性疾病的患者106例，其中42例患者经数字减影血管造影（DSA）证实为髂动脉和／或股动脉闭塞，64例髂动脉和／或股动脉、胭动脉不同程度管腔狭窄，术中采用经导管动脉内溶栓治疗64例，机械开通31例，经皮血管腔内成形术（PTA）101例，支架置入69例（116枚支架），术后随访12～60个月，分析介入治疗后的中长期疗效。【结果】术中未出现血管破裂、穿孔等严重并发症；术后所有患者下肢缺血症状明显减轻或消失。随访期间1例患者于术后15个月死于急性心肌梗死，21例患者再次出现下肢缺血症状，经DSA检查6例内膜增生引起支架阻塞，6例非治疗部位血管病变进展所致下肢缺血，9例溶栓及PTA治疗部位血管再狭窄，均经PTA或支架置入治疗后症状好转出院；其余84例症状无复发，血管超声复查提示管腔通畅、血流良好。【结论】介入治疗下肢动脉缺血性疾病操作创伤小、中长期疗效好，具有良好的临床应用价值。

Middle and Long-term Efficacy of Interventional Therapy for Lower Limb Ischemia

Objective] To explore the middle and long-term efficacy of interventional therapy for lower limb ischemia. Methods]Totally 106 patients with lower limb ischemia were selected. Among all patients, 42 patients were iliac and/ or femoral arterial occlusion and 64 cases were iliac and/or femoral and popliteal arterial stenosis confirmed by digital subtraction angiography（DSA）. Sixty four cases received transcatheter intra-arterial thrombolytic therapy during the operation, and 31 cases underwent artery recanalization by guide wire, and 101 cases underwent percutaneous transluminal angioplasty（PTA）, and 69 cases underwent stent implantation（ll6 stents）. All patients were followed up for 12-60 months. The middle and long-term efficacy after interventional therapy was analyzed. Results] No severe complications such as angiorrhexis and perforation were found during the interventional therapy. The symptoms of lower limb ischemia of all patients after interventional therapy were alleviated or disappeared. During the follow-up, one patient died of acute myocardial infarction at 15 months after interventional therapy, and 21 patients had the symptoms of lower limb ischemia again. DSA showed that stent occlusion caused by intimal hyperplasia occurred in 6 cases, and lower limb ischemia caused by vascular lesions at the site of non-therapy occurred in 6 cases, and the restenosis at the site of thrombolysis and PTA therapy. There patients got better and discharged from the hospital after PTA or stent implantation therapy. The other 84 cases had no recurrence. The result of vascular ultrasound reexamination showed smooth lumens and good blood flow.