Percutaneous Endovascular Treatment for Chronic Limb Ischemia
Percutaneous Endovascular Treatment for Chronic Limb Ischemia
复制标题
慢性肢体缺血的经皮血管内治疗
作者：
Albeir Y. Mousa;J. Rhee;S. Trocciola;R. Dayal;R. B. Beauford;Naveen Kumar;Peter Henderson;J. Mckinsey;N. Morrissey;K. Kent;P. Faries
慢性肢体缺血的经皮腔内血运重建方法传统上被用作辅助或次要治疗模式。本研究检查了通过血管内方法作为主要治疗形式进行治疗的患者的结局。回顾性分析了2000年11月至2002年1月在一家机构接受血管内方法治疗的66例慢性肢体缺血患者（平均年龄71.3岁，范围53 - 92岁）的记录。31例患者有致残性跛行，15例有静息痛，17例有轻微组织缺损，3例有严重组织缺损。66条肢体中有94处病变：股浅动脉45处病变，腘动脉28处病变，胫动脉21处病变。闭塞病变采用内膜下血管成形术治疗。狭窄通过经皮腔内血管成形术（PTA）治疗。病变的中位长度为12 cm。32例患者植入了46枚支架; 34例患者未植入支架。71%（47/66）的病例采用对侧入路，29%（19/66）的病例采用同侧入路。患者随访时进行体格检查、踝臂指数（ABI）和双功超声检查。干预后药物治疗包括阿司匹林和氯吡格雷。长期通畅率与年龄、合并症、危险因素和除血管成形术外支架的使用相关。66例患者中有65例（98%）的血管内治疗在技术上成功。3例病例中发现残余狭窄（<30%），2例患者仅接受PTA，1例患者接受PTA和支架。平均随访时间为6.3个月（范围：6周至15个月）。干预后ABI从平均0.65提高到平均1.01（p < 30.05）。围手术期并发症发生率为9%，包括3例血肿，血栓形成、淋巴囊肿和药物反应皮疹各1例。结局指标包括6个月时的一期通畅率（89%）、辅助一期通畅率（96%）和保肢率（97%）。4例患者发生>50%的再狭窄，2例发生闭塞。6个月时，植入1枚或多枚支架的患者的通畅率为84%（27/32），而未植入支架的患者的通畅率为94%（32/34）（p = NS）。血管内治疗是一种安全、可行和有效的方法，具有较高的短期通畅率，可用作慢性肢体缺血旁路的替代方法。
Percutaneous transluminal methods of revascularization for chronic limb ischemia have traditionally been used as an adjunctive or secondary mode of treatment. This study examines the outcomes of patients treated via endovascular methods as the primary form of treatment. The records of 66 patients (average age, 71.3 years; range, 53 to 92) with chronic limb ischemia treated from November 2000 to January 2002 at a single institution with endovascular methods were retrospectively reviewed. Thirty-one patients had disabling claudication, 15 had rest pain, 17 had minor tissue loss, and 3 had major tissue loss. There were 94 lesions in the 66 limbs: 45 lesions in the superficial femoral artery, 28 lesions in the popliteal artery, and 21 lesions in tibial arteries. Occlusive lesions were treated by subintimal angioplasty. Stenoses were treated by percutaneous transluminal angioplasty (PTA). The median length of the lesions was 12 cm. Forty-six stents were placed in 32 patients; 34 patients did not receive stents. The approach was contralateral in 71% (47/66) and ipsilateral in 29% (19/66) of cases. Patients were followed up with physical exam, anklebrachial index (ABI), and duplex ultrasonography. Postintervention medical treatment included aspirin and clopidogrel. Long-term patency was correlated with age, comorbidities, risk factors, and the use of stents in addition to angioplasty. Endovascular treatment was technically successful in 65 of 66 patients (98%). Residual stenosis (<30%) was found in three cases, two in patients with PTA alone and one patient with PTA and a stent. Mean length of follow-up was 6.3 months (range, 6 weeks to 15 months). Postintervention ABI improved from a mean of 0.65 to a mean of 1.01 (p < 30.05). The perioperative complication rate was 9% and included three cases of hematoma and one case each of thrombosis, lymphocele, and rash reaction to medications. Outcome measures included primary patency (89%), assisted primary patency (96%), and limb salvage (97%) at 6 months. Restenosis of >50% occurred in four patients and occlusion occurred in two. At 6 months, patients with one or more stents had a patency rate of 84% (27/32), whereas those without a stent had a patency rate of 94% (32/34) (p = NS). Endovascular treatment is a safe, feasible, and effective method with a high short-term patency rate and may be used as an alternative to bypass for chronic limb ischemia.
经皮腔内血管成形术治疗肢体威胁性缺血：结果是否证明在旁路移植之前尝试是合理的？
影响因子：
4.3
作者：
Parsons,RE;Suggs,WD;Lee,JJ;Sanchez,LA;Lyon,RT;Veith,FJ
通讯作者：
Veith,FJ