膝下动脉球囊血管成形术治疗重症下肢缺血的临床研究

目的 评价膝下动脉闭塞首选球囊血管成形术的临床治疗效果.方法 2005年12月至2009年5月,对于连续收治且符合手术指征的54例(61条肢体)膝下动脉重度狭窄或闭塞的重症下肢缺血患者,采用膝下动脉球囊血管成形术进行治疗.其中男性37例,女性17例,平均年龄66岁.术前踝肱指数平均0.43±0.27.根据病变部位选择手术方法,膝下动脉病变首选球囊血管成形术,合并髂股动脉病变同时进行血管重建(支架置入或动脉旁路术).结果 髂股动脉重建(28条肢体行支架置入,5条肢体行动脉旁路术)均一期成功.膝下动脉球囊血管成形术57条肢体获得一期成功,技术成功率93.4%.围手术期主要并发症为小腿血肿3例(4.9%),膝下截肢2例(3.3%).术后踝肱指数增加至0.86±0.21,与术前相比差异有统计学意义(P<0.01).本组平均随访时间(16±11)个月,一期通畅率61.1%,21条肢体发生再狭窄(38.9%),其中10条肢体再次接受外科干预,二期通畅率75.9%.截肢3条肢体,总的救肢率91.8%.结论 球囊血管成形术是治疗重症下肢缺血安全有效的方法,可以作为膝下动脉病变首选的外科干预手段.

A clinical study of infrapopliteal balloon angioplasty for patients with critical lower limb ischemia

Objective To evaluate the efficacy of infrapopliteal angioplasty as the first-choice procedure in patients with critical lower limb ischemia. Methods From December 2005 to May 2009,infrapopliteal angioplasty was considered as the first-choice method in consecutive patients with infrapopliteal occlusive disease hospitalized for critical ischemia. Fifty-four patients (61 limbs) with a mean age of 66 years old (37 male and 17 female) underwent infrapopliteal balloon angioplasty. The preoperative ankle branchial index (ABI) was 0.43±0.27. Results Iliofemoral artery revascularization (stenting in 28 limbs and bypass in 5 limbs) were successful. Infrapopliteal balloon dilation was success in 57 limbs, the technical success rate was 93.4%. The major complications were calf hematoma in 3 cases (4.9%), and below-the-knee amputation in 2 cases (3.3%). Postoperative ABI increased to 0. 86±0.21 (P<0.01).Mean follow-up time was (16±11) months. The primary patency rate was 61.1%, restenosis rate was 38. 9% (21 of 54 limbs), and surgical intervention were performed for 10 limbs, the secondary patency rates was 75.9%. Major amputation in 3 limbs during follow-up period, the limb salvage rate was 91.8%.Conclusion Infrapopliteal balloon angioplasty as the first-choice method is feasible, safe and effective for limb salvage in patients with critical lower limb ischemia.