Faglia E, Clerici G, Clerissi J, Caminiti M, Quarantiello A, Curci V, Losa S, Vitiello R, Lupattelli T, Somalvico F
Diabetic Foot Centre-IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
Eur J Vasc Endovasc Surg. 2008 Sep;36(3):331-8. doi: 10.1016/j.ejvs.2008.04.012. Epub 2008 Jun 5.
To evaluate the efficacy of peripheral angioplasty (PTA) in the treatment of diabetic patients with previous peripheral bypass graft and recurrent critical limb ischemia (CLI).
Between January and December 2006, 293 diabetic patients presenting with critical limb ischemia (CLI) according to the TASC 2000 criteria were admitted to our footcare centre. Among these patients, 32 of them had previously undergone bypass grafting: femoropopliteal in 26 patients, femoroposterior tibial in 3 patients, femoroperoneal in the remaining 3. All these patients underwent angiography and, whenever possible, a concomitant PTA procedure.
Six patients presented with stenosis at the distal anastomosis, 2 with stenosis at the proximal anastomosis and in 5 patients both the distal and proximal anastomosis were stenosed. In 12 patients the graft was completely occluded. In 7 patients the graft appeared patent but all the infrapopliteal arteries were occluded. The average time interval between bypass and subsequent hospital admission because of CLI was 6.3+/-4.2 months for patients with patent grafts and 20.5+/-12.0 months for those with failing grafts (p=0.004). A successful PTA was performed in 25 patients (78.1%). In all patients with patent grafts, PTA recanalized one infrapopliteal artery. Recanalization of the graft was obtained in all 13 patients with non-occluded graft. Recanalization of superficial femoral artery occlusion by means of PTA was obtained in 5 out of the 12 patients in whom the graft was completely occluded. Five patients underwent major amputation within 30 days and 3 further patients during the follow-up period. Patients were followed up until December 31 2007, with a mean follow-up of 1.89+/-0.27 years. Restenosis occurred in 7 (28.0%) of the 25 patients in whom a successful PTA was performed. In 5 of these 7 patients, PTA was repeated successfully. In 2 patients in whom a further PTA was not feasible a major amputation was performed. At the end of the follow-up period the cumulative primary patency rate was 72%, the assisted patency rate was 92%.
PTA is an effective method for revascularizing secondary obstructions in patients with graft failure (and no possibility of a redo graft). PTA also is effective in at least one subgenicular artery in patients with diabetes with inadequate run-off after femoropopliteal bypass grafting.
评估外周血管成形术（PTA）治疗既往接受过外周旁路移植术且复发严重肢体缺血（CLI）的糖尿病患者的疗效。
2006年1月至12月期间，根据TASC 2000标准诊断为严重肢体缺血（CLI）的293例糖尿病患者入住我们的足部护理中心。其中32例患者既往接受过旁路移植术：26例为股腘动脉旁路移植术，3例为股后胫动脉旁路移植术，其余3例为股腓动脉旁路移植术。所有这些患者均接受了血管造影，并尽可能同时进行PTA手术。
6例患者远端吻合口处出现狭窄，2例患者近端吻合口处出现狭窄，5例患者远端和近端吻合口均狭窄。12例患者移植血管完全闭塞。7例患者移植血管通畅但所有腘动脉以下血管均闭塞。移植血管通畅的患者因CLI再次入院的平均时间间隔为6.3±4.2个月，移植血管失败的患者为20.5±12.0个月（p = 0.004）。25例患者（78.1%）成功进行了PTA。在所有移植血管通畅的患者中，PTA使一条腘动脉以下血管再通。13例移植血管未闭塞的患者均实现了移植血管再通。在12例移植血管完全闭塞的患者中，5例通过PTA实现了股浅动脉闭塞再通。5例患者在30天内接受了大截肢手术，随访期间又有3例患者接受了大截肢手术。患者随访至2007年12月31日，平均随访时间为1.89±0.27年。25例成功进行PTA的患者中有7例（28.0%）发生再狭窄。这7例患者中有5例成功进行了再次PTA。2例无法进行再次PTA的患者接受了大截肢手术。随访期末，累积原发性通畅率为72%，辅助通畅率为92%。
PTA是一种有效的方法，可使移植血管失败（且无法进行再次移植）的患者继发梗阻血管再通。PTA对于股腘动脉旁路移植术后流出道不足的糖尿病患者，至少使一条膝下动脉再通也是有效的。
