老年下肢动脉硬化泛大西洋共识D级病变患者的腔内治疗  

Percutaneous transluminal angioplasty for lower limb arteriosclerosis in elderly patients with TASC I -D lesions

作　　者：王中华[1] 赵树民 田磊[1] 杨晓冬[1] 陈学东[1] 王世华[1] 姜福亭[1] 王育红[1] 

机构地区：[1]海军总医院普通外科,北京100048 [2]内蒙古自治区通辽市第二医院普通外科

出　　处：《中华老年心脑血管病杂志》2012年第12期1241-1244,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨老年下肢动脉硬化泛大西洋介入学会(TASC)Ⅱ-D级病变患者腔内治疗的技术特点及疗效。方法选取50例我院收治并进行腔内治疗的老年下肢动脉硬化TASCⅡD级病变患者(64条下肢),对腔内治疗的技术方法、疗效、并发症、术后随访等进行总结分析。结果成功进行腔内治疗58条下肢,技术成功率90.6%(58/64),其中单纯行球囊扩张10条下肢,球囊扩张联合支架置入48条下肢。围手术期发生并发症5例,发生率为10.0%(5/50),包括穿刺处假性动脉瘤形成1例、心力衰竭1例、造影剂肾病1例、动脉穿孔2例。围手术期无死亡患者,术前与术后7 d踝肱指数比较,差异有统计学意义(0.40±0.11 vs 0.78±0.14,P<0.001)。术后12、24个月分别随访50条和30条下肢,Ⅰ期通畅率分别为84.0%(42/50)和66.7%(20/30),Ⅱ期通畅率分别为88.0‰(44/50)和76.7%(23/30),24个月保肢率为100%(30/30)。结论对老年患者下肢动脉硬化TASCⅡ-D级病变进行腔内治疗,技术成功率高、保肢率高、并发症少、近期临床效果良好,远期疗效需继续观察。Objective To study the characteristics of percutaneous transluminal angioplasty（PTA） and its curative effect on lower limb arteriosclerosis in elderly patients with TASC ll-D lesions. Methods Fifty elderly patients（64 limbs） with lower limb arteriosclerotic TASC ]I-D lesions un- derwent PTA in our hospital. Its curative effect, complications and follow-up data were analyzed. Results Of the 64 limbs,58 were successfully treated with a success rate of 90.6%（58/64）. Of these 58 limbs, 10 underwent smple balloon dilation and 48 underwent combined balloon dilation and stenting. Complications occurred in 5 patients （10.0 %） during perioperative period （including pseudoaneurysm in 1 patient, heart failure in 1 patient,contrast-induced nephropathy in 1 patient and artery perforation in 2 patients）. No patient died during perioperative period. The Doppler ankle-brachial index（ABI） was higher at 1 week after operation than before operation（0. 78±0. 14 vs 0.40±0.11 ,P〈0. 001）. Fifty and 30 limbs were followed up at 12 and 24 months, respectively, after operation,with a primary patency rate of 84.0% （42/50）and 66.7 % （20/30） respectively and a secondary patency rate of 88.0% （44/50）and 76.7% （23/30） respectively. The 24-month limb salvage rate was 100% （30/30）. Conclusion PTA for lower limb arteriosclerotic TASC Ⅱ-D lesions can achieve a high success rate and a high limb salvage rate with few complications and good short-term clinical outcomes. However, its long-term curative effect needs to be further observed.

关 键 词：下肢 动脉粥样硬化 支架 阿司匹林 血管成形术 气囊 

分 类 号：R543.5[医药卫生—心血管疾病]