下肢动脉闭塞性疾病介入治疗价值.docVIP

下肢动脉闭塞性疾病介入治疗价值 　 作者: 阳建萍，肖运平，肖恩华，罗建光，伍玉枝，朱晖，杨树仁，周顺科 ［摘要］ 目的 探讨介入治疗在下肢动脉闭塞性疾病中的临床应用价值。方法 分析22例（24条肢体）下肢动脉闭塞性病变经导管动脉内溶栓、经皮腔内血管成形术(PTA)及选择性血管内支架置入术后的临床疗效。结果 除2例下肢动脉完全闭塞患者失败外，其余病例经综合介入治疗后均开通，临床症状消失或好转，踝/肱指数由0.17～0.72(平均0.41±0.15)上升为0.55~0.95（平均0.76±0.18），随访6个月~3年，6个月、1年、2年、3年累计初次开通率分别为95.0％、85.0％、75.0％、65.0％。结论 经导管动脉溶栓、PTA及选择性支架置入为主的综合介入治疗是下肢动脉闭塞性疾病有效的治疗方法，但需严格掌握其适应证。 ［关键词］ 动脉闭塞性疾病；下肢；放射学，介入性 Value of interventional therapy in the treatment of lower extremity arterial occlusive diseases ［Abstract］ Objective To discuss the value of interventional therapy in the treatment of lower extremity arterial occlusive diseases.Methods 22 patients(24 limbs) with lower extremity artery occlusive diseases were treated by transcatheter arterial thrombolysis，PTA and selective stent implantation.Results Except for 1 patient with arterial wholly occlusive lower limbs，the patients therapy was successful，their clinical symptoms were improved or disappeared，and the ankle/brachial index of 0.41±0.15 increased to 0.76±0.18 after treatment，the endovascular cumulative primary-assisted patency rates at 6 months，1 year，2 years，3 years were respectively 95.0％，85.0％，75.0％，65.0％ during the subsequent follow-up of 6 months-3 years.Conclusion Compositive interventional therapy including transcatheter arterial thrombolysis，PTA and selective stent implantation is effective in treatment of lower extremity artery occlusive disease，we should strictly control those indications. ［Key words］ arterial occlusive diseases；lower extremity；radiology，interventional 近年来，以动脉硬化为主的下肢动脉闭塞性疾病发病率不断上升，随着介入放射学的发展，经导管动脉内溶栓、经皮腔内血管成形术(percutaneous transluminal angioplasty，PTA)及血管内支架置入术治疗下肢闭塞性病变已普遍开展［1］。笔者收集22例(24条肢体)经腔内介入治疗的患者，进一步探讨其介入治疗价值及适应证，结合文献，报告如下。 1 资料与方法 1.1 一般资料 男17例，女5例，年龄32～73岁，平均57.3岁；动脉硬化闭塞症12例，血栓闭塞性脉管炎4例，糖尿病所致动脉闭塞2例，Forgarty导管取栓术后复发血栓2例，风心病附壁栓子脱落闭塞1例，外伤后动脉狭窄并发血栓 1例；急性发病7例，病程5 h~6天，主要症状为足背动脉搏动减弱或消失、下肢肿痛、皮肤发绀、感觉运动异常；慢性发病15例，病程2~18个月，主要症状为患肢静息痛、皮温低、间歇性跛行。踝/肱指数（ankle/brachial index，ABI）测定：0.17～0.7