摘要:
目的 评价腔内成形术治疗单纯膝下动脉疾病导致严重下肢缺血的技术可行性、 近中期疗效及安全性.方法 回顾性分析2015年1月至2018年3月收治的317例(322条患肢)膝下动脉闭塞性病变患者的临床资料,采用腔内成形技术,顺行或逆行成功通过病变,对闭塞段行球囊扩张治疗.比较所有患者术前术后的视觉疼痛评分(VAS),踝肱指数(ABI),经皮氧分压(TcPO2)和溃疡愈合情况.结果 317例患者(322条患肢)技术成功率86.65%(279/322).VAS疼痛评分、ABI分别从术前的6.25±1.42、0.25±0.08,改善为术后1周内的3.78±1.37、0.76±0.14,术后6个月的1.16±0.29、0.64±0.21,术后12个月的0.64±0.13、0.55±0.19,手术前后比较差异均有统计学意义(P均<0.05);TcPO2从术前的(25.37±6.42)mmHg上升至术后的(36.81±5.35)mmHg,手术前后比较差异均有统计学意义(P均<0.05).术后2例出现穿刺点假性动脉瘤,1例行覆膜支架植入,1例在彩超引导下压迫后消失.随访1年,4例患者行膝下截肢术;2例死于心肌梗死,3例死于脑血管意外.结论 膝下动脉腔内成形术治疗严重下肢缺血技术成功率高,并发症少,近中期疗效满意.%Objective To evaluate the feasibility, short-and mid-term efficacy and safety of endovas-cular therapy for critical limb ischemia (CLI ) caused by isolated below-the-knee arterial lesions . Methods Clinical data were reviewed on 317 CLI patients (322 limbs) suffered from occlusive lesions limited to below-the-knee arteries from January 2015 to March 2018. These patients were treated with arterioplasty, and balloon dilation was successfully performed through the occluded segments by anterograde or retrograde technique. Visual pain scores (VAS), ankle-brachial index (ABI), percutaneous oxygen pressure (TcPO 2), and ulcer healing were compared between pre- and post-operation in all patients. Results The technical success rate of 317 patients (322 limbs) was 86.65%(279/322). VAS and ABI respectively improved from 6.25 ±1.42 and 0.25±0.08 (before surgery) to 3.78±1.37 and 0.76±0.14 (1 week after surgery), 1.16±0.29 and 0.64±0.21 (6 months after surgery), and 0.64±0.13 and 0.55±0.19 (12 months after surgery). The differences of VAS and ABI before and after surgery were statistically significant (P<0.05). TcPO2 increased from (25.37±6.42) mmHg to (36.81± 5.35) mmHg, with statistically significant differences before and after surgery (P<0.05). Pseudoaneurysm occurred in two cases at the puncture site, one case was treated with stent-graft implantation, and one case with pseudoaneurysm disappearing after compression guided by ultrasound. After one-year follow-up, four patients suffered below-the-knee amputation. Two patients died of myocardial infarction, and three patients died of cerebrovascular accidents. Conclusion The endovascular therapy of CLI caused by below-the-knee arterial lesions has high success rate and few complications, while the short- and mid-term efficacy is satisfactory.