糖尿病患者下肢动脉病变血管造影表现及介入治疗的近期疗效观察

目的 探讨糖尿病患者下肢动脉病变血管造影表现及介入治疗的近期临床疗效.方法 回顾性分析38例(44条患肢)糖尿病患者下肢动脉病变血管造影表现及介入治疗后1周,1、3、6、12个月的临床表现、体征及踝-肱指数(ABI)的变化和治疗效果.临床疗效评估分为显效、有效、无效和恶化4个等级.有效率=(显效+有效)/总例数×100%.ABI结果的比较采用方差分析.结果 血管造影显示,糖尿病患者下肢动脉病变为多支病变,呈多节段、广泛性狭窄或闭塞.25条(56.8%,25/44)患肢膝上和膝下动脉均有病变;1条(2.3%,1/44)患肢单纯膝下1支动脉病变;6条(13.6%,6/44)患肢2支动脉病变;9条(20.5%,9/44)患肢3支动脉病变;3条(6.8%,3/44)患肢单纯膝上动脉病变.膝下动脉经皮腔内血管成形术(PTA)技术成功率为91.4%(53/58).12例足踝部溃疡患者3个月内愈合9例,6个月内踝下截肢1例,膝下截肢2例;4例坏疽患者1个月内膝下截肢,截肢率15.9%(7/44).介入综合治疗后1周,1、3、6和12个月的有效率分别为79.6%(35/44)、83.3%(30/36)、85.7%(24/28)、85.0%(17/20)和81.3%(13/16);ABI值分别为0.86±0.10、0.85±0.10、0.83±0.11、0.79±0.12和0.75±0.12,较术前0.53±0.20明显升高(F=35.79,P＜0.05),但术后6个月ABI值开始出现下降趋势.结论 糖尿病患者下肢动脉病变以膝下动脉病变合并膝上动脉病变最为常见,介入治疗能有效改善患者下肢动脉缺血的症状和体征,短期随访临床疗效满意.

Diabetic peripheral arterial disease: lower limb angiography results and one year outcomes of interventional treatment

Objective To demonstrate lower limb angiography results of peripheral arterial disease (PAD) in diabetics and evaluate one-year curative effect after interventional therapy. Methods Lower limb angiography results and the efficiency of interventional therapy for 44 limbs with PAD in 38 diabetics were retrospectively analyzed. Post-treatment clinical manifestations, signs and ankle-brachial-index (ABI) at 1 week, 1 month, 3 months, 6 months and 12 months were compared with those before treatment. Clinical evaluation was divided into four grades: apparent, effective, ineffective and deterioration. Efficiency =(apparent + effective ) / total cases ÷ 100%. ABI was compared using analysis of variance. Results Lower limb angiography revealed multi-branch lesions, with multi-segmental stenoses or obstructions.Lesions involved both above- and below-the-knee arteries in 25 limbs (56. 8% ), only above-the-knee arteries in 3 limbs (6. 8% ) and only below-the-knee arteries in 16 limbs (36. 4% ). In the limbs only with below-the-knee arterial lesions, the involved artery branches were one in one limb (2. 3% ), two in six limbs ( 13. 6% ) and three in nine limbs ( 20. 5% ), respectively. The technical success rate of percutaneous transluminal angioplasty (PTA) was 91.4% ( 53/58 ) for diseased below-the-knee arteries. Among the 12 cases with foot and ankle ulcers, ulcers healed within 3 months in 9 cases; however, the other three cases suffered below-the-ankle (in one case) or below-the-knee amputation (in two cases) within 6 months. Four cases with gangrene suffered below-the-knee amputation within one month after PTA. The amputation rate was 15. 9% (7/44). At 1 week, 1, 3, 6 and 12 months after PTA, the effective rates were 79. 6%(35/44), 83.3% (30/36), 85.7% (24/28), 85.0% (17/20) and 81.3% ( 13/16), respectively; ABI values were 0. 86 ± 0. 10, 0. 85 ± 0. 10, 0. 83 ± 0. 11, 0. 79 ± 0. 12 and 0. 75 ± 0. 12, respectively.Compared with pre-PTA ABI value (0. 53 ±0. 20), post-PTA ABI value was significant higher (F=35.79,P ＜ 0. 05 ). However, ABI value began to decline from the 6th month after PTA. Conclusions In diabetics, PAD always involves both above- and below-the-knee arteries. PTA is a feasible and effective revascularization therapy, which could improve the clinical signs and symptoms of lower limb ischemia in diabetics with PAD. The clinical effect is satisfactory during short-term follow-up.