Angiosome指导下膝下动脉成形术治疗合并糖尿病的Fontaine1V级下肢动脉缺血

目的探讨Angiosome指导下膝下动脉成形术的临床价值。方法2011年1月～2012年2月20例合并糖尿病的FontaineIV级缺血（ABI：0．10～0．22，平均0．15），按照Angiosome概念评价足部破损区域的靶血管并开通，其中胫前动脉7例，胫后动脉10例，胫前后动脉3例。患肢股浅动脉顺行穿刺，应用V18导丝及Reekross18球囊导管开通闭塞的靶血管，AmphirionDeep球囊行成形术。术后即时测定患肢踝肱指数（anklebrachialindex，ABI），术后1、3、6个月采用血管多普勒和CTA／NCMRA以及局部切口愈合情况评价血管开通、通畅性和创面修复情况，同时记录有无截肢事件发生。结果20例均成功开通靶血管，无相关并发症发生。术后即时AB10．86±0．06，较术前0．154-0．03显著提高（t=-45．603，P=0．000）。术后1、3、6个月时靶血管的通畅率分别为100％（20／20）、95％（19／20）、75％（15／20）。术后6个月保肢率为100％，85％（17／20）的患肢6个月时完全愈合。结论Angiosome指导下膝下动脉成形术治疗合并糖尿病的FontaineIV级缺血安全可行，有助于保肢及促进创面愈合的治疗。

Infrapopliteal Angioplasty Based on Angiosome Concept for Lower Extremity Ischemia with Fontaine Stage

Objective To evaluate the clinical value of infrapopliteal angioplasty based on Angiosome concept. Methods Twenty patients with Fontaine stage IV ischemia（ ABI：0.10 - 0.22 ; mean, 0.15 ） complicated with diabetes mellitus were performed by infrapopliteal angioplasty based on Angiosome concept from January 2011 to February 2012. The target vessels in foot damaged area were evaluated and opened based on Angiosome concept, including anterior tibial artery in 7 cases, posterior tibial artery in 10, anterior and posterior tibial artery in 3. Anterograde puncture of superficial femoral artery was performed on all cases, and V18 combined with Reekross 18 balloon catheter was used to perform recanalization. The Amphirion Deep balloon was used to accomplish angioplasty. Curative effect evaluation was carried out on postoperative ABI, and healing of ischaemic wounds including target arterial patency and healing rate based on vascular ultrasonography, CTA/NCMRA or local incision recovery 1,3,6 months postoperatively. Amputation was recorded. Results All the target arteries were successfully revascularized without complications. Postoperative ABI was 0.86 ＋ 0.06, which was significantly higher than that of preoperation （0. 15 ＋ 0.03, t -- -45. 603, P = 0. 000）. The target arterial patency rate was 100% （20/20） , 95% （19/20） and 75% （15/20） respectively 1, 3, 6 months after operation. Limb-salvage rate was 100% and the healing rate of wounds was 85% （17/20） 6 months after operation. Conclusion Infrapopliteal angioplasty based on Angiosome concept is a safe and feasible procedure for the treatment of lower extremity ischemia with Fontaine stage IV caused by diabetes, with better wound healing of diabetic foot ulcers and subsequent limb salvage.