Cho Sung Ki, Do Young Soo, Shin Sung Wook, Park Kwang Bo, Kim Dong-Ik, Kim Young Wook, Kim Duk-Kyung, Choo Sung Wook, Choo In Wook
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Radiol. 2006 Apr-Jun;7(2):131-8. doi: 10.3348/kjr.2006.7.2.131.
To present our experience with subintimal angioplasty (SA) for treatment of chronic lower limb ischemia (CLLI) and to assess its effectiveness and durability.
From April 2003 through June 2005, we treated 40 limbs in 36 patients with CLLI by SA. Balloons with or without secondary stent placement appropriate in size to the occluded arteries were used for SA of all lesions, except for iliac lesions where primary stent placement was done. The patients were followed for 1-23 months by clinical examination and color Doppler ultrasound and/or CT angiography. Technical results and outcomes were retrospectively evaluated. The presence of a steep learning curve for performance of SA was also evaluated. Primary and secondary patencies were determined using Kaplan-Meier analysis.
Technical success was achieved in 32 (80%) of 40 limbs. There was no statistical difference between technical success rates of 75% (18/24) during the first year and 88% (14/16) thereafter. There were four complications (10%) in 40 procedures; two arterial perforations, one pseudoaneurysm at the puncture site, and one delayed hematoma at the SA site. Excluding initial technical failures, the primary patency rates at six and 12 months were 68% and 55%, respectively. Secondary patency rates at six and 12 months were 73% and 59%, respectively.
Subintimal angioplasty can be accomplished with a high technical success rate. It should be attempted in patients with CLLI as an alternative to more extended surgery, or when surgical treatment is not recommended due to comorbidity or an unfavorable disease pattern.
介绍我们采用内膜下血管成形术（SA）治疗慢性下肢缺血（CLLI）的经验，并评估其有效性和持久性。
2003年4月至2005年6月，我们对36例CLLI患者的40条肢体进行了SA治疗。除髂动脉病变采用一期支架置入外，所有病变均使用尺寸适合闭塞动脉的带或不带二期支架置入的球囊进行SA。通过临床检查、彩色多普勒超声和/或CT血管造影对患者进行1至23个月的随访。对技术结果和疗效进行回顾性评估。还评估了SA操作中是否存在陡峭的学习曲线。使用Kaplan-Meier分析确定一期和二期通畅率。
40条肢体中有32条（80%）获得技术成功。第一年的技术成功率为75%（18/24），此后为88%（14/16），两者之间无统计学差异。40例手术中有4例（10%）出现并发症；2例动脉穿孔，1例穿刺部位假性动脉瘤，1例SA部位迟发性血肿。排除初始技术失败病例，6个月和12个月时的一期通畅率分别为68%和55%。6个月和12个月时的二期通畅率分别为73%和59%。
内膜下血管成形术可获得较高的技术成功率。对于CLLI患者，当需要替代更广泛的手术，或因合并症或疾病模式不佳而不建议进行手术治疗时，应尝试采用该方法。
