Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: do the results justify an attempt before bypass grafting?
Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: do the results justify an attempt before bypass grafting?
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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？
DOI：
10.1016/s0741-5214(98)70033-3
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发表时间：
1998
影响因子：
4.3
通讯作者：
Veith,FJ
中科院分区：
文献类型：
--
作者：
Parsons,RE;Suggs,WD;Lee,JJ;Sanchez,LA;Lyon,RT;Veith,FJ
目的经皮腔内血管成形术(PTA)在部分病例中的治疗效果与动脉旁路移植术相当或优于动脉旁路移植术，且具有较低的并发症和死亡率。我们对肢体威胁的缺血患者进行了狭窄或闭塞病变的PTA，希望提高我们的总体成功率，降低这类患者的发病率。方法1992~1995年，共对257例患者施行了307次PTA。161例(63%)患者有糖尿病，32例(12%)患者有肾功能衰竭。所有患者在PTA术后1周、6周及术后3个月分别进行脉搏容积记录和踝臂指数评估。失访17例(9%)。根据无创血管实验室标准、脉搏检查的通畅率、是否需要通过指标性病变再次搭桥以及保肢来判断PTA的持续成功与否。结果髂外PTA的1年通畅率(56%)显著低于普通PTA(87%)。股、窝和胫骨水平的腹股沟下PTA 1年通畅率低于15%。结论在大多数可行的病例中，髂总动脉PTA是合理的。然而，当PTA在腹股沟韧带下方进行时，结果明显更差。在这组四肢受威胁的患者中，PTA的一年通畅率低于动脉搭桥术的通畅率，即使这些搭桥术是使用假体材料进行的。PTA不应被认为是腹股沟下动脉闭塞症患者的主要治疗方式，这些患者也有威胁肢体的缺血，除非在特殊情况下。(《血管外科杂志》1998；28：1066-71。)
PurposeResults of percutaneous transluminal angioplasty (PTA) in selected cases have been reported to be equal or superior to those of arterial bypass graft surgery, with a lower morbidity and mortality. We performed PTA of stenotic or occlusive lesions in patients with limb-threatening ischemia, hoping to improve our overall success and decrease morbidity in this group of patients. The results of PTA in the limb-salvage setting was evaluated.MethodsFrom 1992 to 1995, 307 PTAs were performed in 257 patients. One hundred sixty-one (63%) patients had diabetes mellitus, and 32 (12%) patients had renal failure. All patients were evaluated by means of pulse volume recordings and ankle brachial indices at 1 and 6 weeks after PTA and at 3 month intervals thereafter. Seventeen patients (9%) were lost to follow-up. The continued success or failure of PTA was defined by means of noninvasive vascular laboratory criteria, patency by means of pulse examination, the need for subsequent bypass grafting across the index lesion, and limb salvage.ResultsThe 1-year patency rates for external iliac PTAs (56%) were significantly lower (P < .05) than those for common iliac PTAs (87%). Infrainguinal PTAs at the femoral, popliteal, and tibial level had 1-year patency rates of less than 15%.ConclusionCommon iliac artery PTA is justified in most cases in which it is feasible. However, when PTAs are performed below the inguinal ligament, the results are markedly worse. One-year patency rates of PTA in this group of patients with threatened limbs are inferior to the patency rates of arterial bypass grafts, even when these bypasses are performed with a prosthetic material. PTA should not be considered as a primary treatment modality for patients with infrainguinal arterial occlusive disease who also have limb-threatening ischemia, except in unusual circumstances. (J Vasc Surg 1998;28:1066-71.)