踝下动脉粥样硬化病变腔内重建的疗效分析  

Analysis of endovascular therapy for below-the-ankle arteriosclerosis occlusive disease

作　　者：张童[1] 曹战江[1] 赵克强[1] 赵俊来[1] 杨宇[1] 蒋超[1] 朱融融[1] 吴巍巍[1] Zhang Tong;Cao Zhanjiang;Zhao Keqiang;Zhao Junlai;Yang Yu;Jiang Chao;Zhu Rongrong;Wu Weiwei(Department of Vascular Surgery,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院(清华大学临床医学院)血管外科,北京102218

出　　处：《中国医师杂志》2022年第12期1789-1794,共6页Journal of Chinese Physician

摘　　要：目的分析踝下动脉粥样硬化病变腔内重建技术(包括液压扩张、减容、抑制再狭窄技术)治疗慢性肢体威胁性缺血的疗效。方法回顾性分析2018年4月至2021年12月清华大学附属北京清华长庚医院连续收治的465例踝下动脉粥样硬化病变患者(570条肢体)患者的临床资料,均接受踝下动脉球囊扩张成形作为基础治疗,其中联合减容技术67例,联合抑制再狭窄技术82例,三者联合11例。比较术后1、3、6及12个月的再闭塞率、目标病变再干预率,GLASS分级P0、P1、P2组3个月内的伤口愈合率,6、12个月的保肢率及12个月的病死率。结果本组手术技术成功率为76.0%(433条/570条),术后6、12个月随访率分别为85.4%(370条/433条)及75.3%(326条/433条),治疗病变的长度为(3.6±1.3)cm;术后1、3、6、12个月再闭塞率依次为5.5%(23条/420条)、8.2%(33条/403条)、14.9%(55条/370条)和23.6%(77条/326条);6、12个月的目标病变再干预率分别为7.6%(28条/370条)和12.0%(39条/326条);P0、P1和P2组3个月内的伤口愈合率分别为87.3%(192条)、70.5%(62条)及10.5%(2条)(P<0.001),6个月的保肢率分别为96.2%(200条)、84.7%(127条)及33.3%(4条)(P<0.001),12个月的保肢率分别为78.7%(170条)、54.5%(55条)及22.2%(2条)(P<0.001)。术后12个月病死率为6.9%(32/465)。结论踝下动脉粥样硬化病变腔内重建可行且具有较高技术成功率,其肢体威胁期足背足底弓动脉完整程度与3个月内伤口愈合率及保肢率相关。Objective To analyze the effect of endovascular therapy(including balloon dilation,debulking and anti-restenosis technique)for below-the-ankle atherosclerotic lesions in chronic limb threatening ischemic patients.Methods A retrospective analysis was performed on the clinical data of 465 patients(570 limbs)with below-the-ankle atherosclerosis who were consecutively admitted to Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University from April 2018 to December 2021.All patients received balloon dilatation below the ankle artery as basic treatment,including 67 patients in debulking subgroup,82 patients in anti-restenosis subgroup and 11 patients in the triple therapy subgroup.The reocclusion rate,target lesion reintervention rate at 1,3,6 and 12 months after surgery were compared;The wound healing rate at 3 months,limb salvage rate at 6 and 12 months and mortality at 12 months in the Global Limb Anatomic Staging System(GLASS)grading groups P0,P1 and P2 were compared.Results The technical success rate of this group was 76.0%(433 limbs/570 limbs).The follow-up rates of 6 and 12 months after operation were 85.4%(370 limbs/433 limbs)and 75.3%(326 limbs/433 limbs),respectively.The length of treated lesions was(3.6±1.3)cm;The reocclusion rates were 5.5%(23 limbs/420 limbs),8.2%(33 limbs/403 limbs),14.9%(55 limbs/370 limbs)and 23.6%(77 limbs/326 limbs)at 1,3,6 and 12 months after operation;The reintervention rate of target lesions in 6,12 months was 7.6%(28 limbs/370 limbs)and 12.0%(39 limbs/326 limbs)respectively;The wound healing rate in groups P0,P1 and P2 within 3 months was 87.3%(192 limbs),70.5%(62 limbs)and 10.5%(2 limbs)respectively(P<0.001),the limb salvage rate in 6 months was 96.2%(200 limbs),84.7%(127 limbs)and 33.3%(4 limbs)respectively(P<0.001),and the limb salvage rate in 12 months was 78.7%(170 limbs),54.5%(55 limbs)and 22.2%(2 limbs)respectively(P<0.001).The mortality was 6.9%(32/465)12 months after operation.Conclusions Endovascular therapy below-the-ankle is feasible and has high technical

关 键 词：动脉粥样硬化 足背足底弓 血管内操作 

分 类 号：R654.4[医药卫生—外科学]