经皮腔内球囊扩张联合动脉内灌注药物治疗慢性下肢缺血

目的临床观察球囊扩张联合动脉内灌注药物治疗慢性下肢缺血的近期疗效。方法慢性下肢缺血患者21例,采用经股或腋动脉入路,先用球囊扩张闭塞段血管,然后经导管向动脉内灌注尿激酶、前列腺素E1、银杏叶注射液。胫腓动脉闭塞的部分患者保留血管鞘,经鞘灌注上述药物,每日1次,共5～7 d。术后观察患肢缺血症状、皮肤溃疡和趾端坏疽的改善情况。结果21例中20例成功实现经皮经腔球囊扩张和动脉内灌注药物治疗,技术成功率95.2%。无严重并发症。其中5例患者术后保留血管鞘,灌注药物5～7 d后复查造影,显示经球囊扩张后血管腔保持通畅。术后20例患者均出现诸如患肢皮温升高、间歇性跛行消失、静息痛减轻或消失等临床症状改善情况;随访2～7个月,4例皮肤溃疡愈合,2例坏死足趾脱落,创面愈合,已坏疽的足趾均变干燥,坏死范围停止扩大,未出现需截肢现象。结论经皮腔内球囊扩张联合动脉内灌注尿激酶、前列腺素E1、银杏叶注射液治疗慢性下肢缺血安全有效,能够改善肢体缺血症状,促进溃疡愈合,阻止病变发展;保留血管鞘连续灌注药物有助于保持扩张后的血管通畅。

Percutaneous transluminal angioplasty combining intraarterial drug perfusion for the treatment of chronic lower limb ischemia

Objective To evaluate the clinical effects of balloon angioplasty in combination with intraarterial perfusion of vasoactive drugs in the treatment of chronic lower limb ischemia.Methods A total of 21 patients were treated with percutaneous transfemoral or transaxillary approach of balloon dilatation of the occlusive arterial segments,and then followed by perfusion of urokinase,Lipo prostaglandin E1 and ginkgo leaf injection,respectively,into the responsible arteries via the catheter.Postoperatively,some of the patients with tibioperoneal arteries occlusion were perfused with the same drugs into their diseased arterial segments,one time per day altogether 5-7 times,through the ipsilateral femoral arterial sheath reserved temporarily,and then followed by observation for improvement of ischemia,superficial ulceration and gangrenous change.Results Of the 21 patients,20 were successfully treated with percutaneous transluminal balloon dilation and arterial perfusion with a technical successful rate of 95.2%(20/21).Five of the total 20 were additionally treated with the same drugs perfusion 5-7 days through the retained sheath,showing well patency.No serious complications occurred and ischemic symptoms of limbs improved,such as rest pain,claudication and dermo temperature.During 2-7 months follow-up,healing of skin ulcer occurred in 4 patients and breakoff of necrotic digits in 2 with the surface wound healed.Necrotic toes in all patients were dehydrated with stopping of necrosis and without any amputation.Conclusions Percutaneous transluminal angioplasty combining intraarterial drug perfusion is safe and effective for promoting blood circulation with healing of ulceration and ceasing the development of lesions;with furthermore of maintaining the arterial patency through the retained vascular sheath for sustaining the drug plerfusion.