Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Vídenská 1958/9, 14021 Prague 4, Czech Republic.
Cardiovasc Intervent Radiol. 2010 Aug;33(4):720-5. doi: 10.1007/s00270-010-9881-3. Epub 2010 May 11.
This study was a retrospective analysis of patients with CLI who underwent infrapopliteal percutaneous transluminal angioplasty (PTA). The main goal was to evaluate clinical and morphological factors that influence the clinical outcome of PTA in long-term follow-up. A total of 1,445 PTA procedures were performed in 1,268 patients. Main indications for PTA included gangrene, nonhealing ulcers, or rest pain. The mean number of treated arteries was 1.77 artery/limb, and the majority of lesions were type TASC D. The technical success rate of PTA was 89% of intended-to-treat arteries. The main criterion of clinical success was functional limb salvage (LS). One-year follow-up involved 1,069 limbs. Primary and secondary 1-year LS rates were 76.1 and 84.4%, respectively. The effect of clinical and morphological parameters on the 1-year LS was that the only associated disease with an adverse effect on LS rate was DM combined with dialysis. Regarding limb preprocedural status, gangrene was clearly a negative predictor. The most important factor affecting LS was the number of patent arteries post-PTA: patients with 0, 1, 2, and 3 patent arteries had 1-year primary LS rates of 56.4, 73.1, 80.4, and 83%, respectively. Long-term follow-up of LS rates demonstrated secondary LS rates of 84.4, 78.8, and 73.3% at 1, 5, and 10 years. Every effort should be made to perform PTA for as many arteries as possible, even if TASC D type, to improve clinical outcome. Our study shows that repeat PTA is capable of keeping the long-term LS rate close to 75%.
本研究回顾性分析了接受下肢经皮腔内血管成形术（PTA）的 CLI 患者。主要目标是评估影响 PTA 长期随访临床结果的临床和形态学因素。共对 1268 例患者的 1445 次 PTA 手术进行了分析。PTA 的主要适应证包括坏疽、不愈合溃疡或静息痛。治疗的动脉平均数量为 1.77 条/肢体，大多数病变为 TASC D 型。PTA 的技术成功率为 89%的意向治疗动脉。临床成功的主要标准是功能性肢体保存（LS）。1 年随访涉及 1069 条肢体。主要和次要的 1 年 LS 率分别为 76.1%和 84.4%。临床和形态学参数对 1 年 LS 的影响是，唯一对 LS 率有不利影响的合并疾病是合并透析的 DM。关于肢体术前状态，坏疽显然是一个负面预测因素。影响 LS 的最重要因素是 PTA 后通畅动脉的数量：0、1、2 和 3 条通畅动脉的患者 1 年主要 LS 率分别为 56.4%、73.1%、80.4%和 83%。LS 率的长期随访显示，1、5 和 10 年的次要 LS 率分别为 84.4%、78.8%和 73.3%。应尽一切努力尽可能对更多的动脉进行 PTA，即使是 TASC D 型，以改善临床结果。我们的研究表明，重复 PTA 能够使长期 LS 率接近 75%。
