Department of Internal Medicine I, Angiology, Cardiology, Park Hospital Leipzig, Leipzig, Germany.
Catheter Cardiovasc Interv. 2010 Dec 1;76(7):1047-54. doi: 10.1002/ccd.22658.
Restenosis-rate after balloon-angioplasty of long segment tibial arterial disease is largely unknown. We investigated the restenosis-rates angiographically in patients with critical limb ischemia (CLI) due to extensive infrapopliteal lesions.
Angioplasty for infrapopliteal lesions exclusively ≥80 mm in length was performed using dedicated 80-120 mm long low-profile balloons. Follow-up included angiography at 3 months and clinical assessment at 3 and 15 months.
Angioplasty was performed in 77 infrapopliteal arteries of 62 limbs of 58 CLI patients with a Rutherford class 4 in 16 (25.8%) limbs and Rutherford class 5 in 46 limbs (74.2%). Average lesion length was 18.4 cm. Treated arteries were stenosed in 35.1% and occluded in 64.9%. After 3 months, a clinical improvement (marked reduction of ulcer-size or restpain) was seen in 47 (75.8%) limbs, 14 (22.6%) limbs were clinically unchanged and 1 (1.6%) limb showed a clinical deterioration. Angiography at 3 months showed no significant restenosis in 24 of 77 (31.2%) treated arteries, a restenosis ≥50% in 24 (31.2%) arteries and a reocclusion in 29 of 77 (37.6%). At 15 months death rate was 10.5%. After repeat angioplasty in case of restenosis cumulative clinical results at 15 months were minor amputations in 8.1%, no major amputations resulting in a limb-salvage rate of 100% with no patient requiring bypass surgery.
Restenosis-rate after angioplasty of extensive infrapopliteal arterial disease is high and occurs early after treatment. Despite this the clinical results are excellent, especially given the length of the arterial segments diseased.
球囊血管成形术后长段胫骨动脉疾病的再狭窄率尚不清楚。我们研究了因广泛的膝下病变导致的严重肢体缺血（CLI）患者的血管造影再狭窄率。
使用专用的 80-120mm 长的低剖面球囊对长度≥80mm 的膝下病变进行血管成形术。随访包括术后 3 个月的血管造影和术后 3 个月和 15 个月的临床评估。
77 条膝下动脉中的 62 条肢体（58 例 CLI 患者）接受了血管成形术，其中 16 条肢体（25.8%）的 Rutherford 分级为 4 级，46 条肢体（74.2%）的 Rutherford 分级为 5 级。平均病变长度为 18.4cm。治疗后的动脉狭窄率为 35.1%，闭塞率为 64.9%。术后 3 个月，47 条肢体（75.8%）临床症状改善（溃疡面积明显缩小或静息痛减轻），14 条肢体（22.6%）临床症状无变化，1 条肢体（1.6%）临床症状恶化。术后 3 个月血管造影显示，24 条（31.2%）治疗动脉无明显再狭窄，24 条（31.2%）动脉再狭窄≥50%，29 条（37.6%）动脉再闭塞。术后 15 个月死亡率为 10.5%。再狭窄行重复血管成形术后，15 个月的累积临床结果为 8.1%的小截肢，无大截肢，保肢率为 100%，无患者需要旁路手术。
广泛膝下动脉病变血管成形术后的再狭窄率较高，且发生在治疗后早期。尽管如此，临床结果仍然很好，尤其是考虑到病变动脉段的长度。
