Taneja Manish, Tay Kiang Hiong, Dewan Atul, Sebastian Mathew G, Pasupathy Shanker, Lin Sheuh En, Teo Terence, Lo Richard, Tan Seck Guan, Irani Farah G, Tan Bien Soo
Department of Radiology, Interventional Radiology Center, Singapore General Hospital, Singapore 169608, Singapore.
Cardiovasc Revasc Med. 2010 Oct-Dec;11(4):232-5. doi: 10.1016/j.carrev.2009.10.002.
To evaluate our experience of limb salvage with bare nitinol stent enabled recanalization of long length occlusions of superficial femoral artery (SFA) and adjacent proximal popliteal artery (PPA) in diabetic patients.
A total of 573 patients underwent 842 lower limb interventions from August 2006 to September 2008 at our institute. A retrospective review was done of diabetic patients undergoing recanalization of long length SFA/adjacent PPA (>10 cm) occlusions with self expanding bare nitinol stents evaluating their impact on limb salvage.
Forty-four patients (mean age 65.2 years, M:F 25:19) underwent 49 long-length (>10 cm) SFA/PPA stenting procedures over a period of 26 months. Diabetics comprised 66% of patients (n=29, mean age: 63.7 years, M: F 19:10). The infrapopliteal distal run-off in this diabetic subgroup comprised one vessel (n=14/29, 48%), two vessels (n=12/29, 41%), and three vessels (n=3/29, 10%). The spectrum of critical limb ischemia included rest pain (n=8), ulcer (n=7) and gangrene (n=14). The lengths of occlusions recanalized were 10-39 cm. A total of 58 stents (individual length 10-17 cm, average diameter 6 mm, mean 2 stents per patient) were placed with average length of stented segment being 23.8 cm. Four patients had stents placed through ipsilateral popliteal artery approach with rest placed through femoral artery approach. Significant complications of the procedure included distal embolization (n=3) successfully managed with thrombolysis and popliteal arteriovenous fistula in one patient undergoing recanalization through popliteal approach, managed with covered stent placement. No procedure related mortality occurred during thirty-day follow-up period. All were followed up over an average duration of twelve months post-procedure. Three patients died due to associated medical conditions during this period. The following amputations were done on follow-up (three toe amputations, five forefoot amputations, three below-knee amputations, two above-knee amputations). The overall limb salvage rate was 80%.
Our study shows beneficial result of SFA/PPA stent placement in diabetic occlusions with significant concomitant infrapopliteal disease.
评估我们使用裸露镍钛诺支架使糖尿病患者股浅动脉（SFA）和邻近腘动脉近端（PPA）的长段闭塞再通以挽救肢体的经验。
2006年8月至2008年9月，我院共有573例患者接受了842次下肢介入治疗。对使用自膨式裸露镍钛诺支架使SFA/邻近PPA长段（>10 cm）闭塞再通的糖尿病患者进行回顾性分析，评估其对肢体挽救的影响。
44例患者（平均年龄65.2岁，男:女为25:19）在26个月内接受了49次SFA/PPA长段（>10 cm）支架置入手术。糖尿病患者占患者总数的66%（n = 29，平均年龄63.7岁，男:女为19:10）。该糖尿病亚组中腘动脉以下远端流出道情况为单支血管（n = 14/29，48%）、两支血管（n = 12/29，41%）和三支血管（n = 3/29，10%）。严重肢体缺血的类型包括静息痛（n = 8）、溃疡（n = 7）和坏疽（n = 14）。再通的闭塞段长度为10 - 39 cm。共置入58枚支架（单枚长度10 - 17 cm，平均直径6 mm，平均每位患者2枚），置入支架段的平均长度为23.8 cm。4例患者通过同侧腘动脉途径置入支架，其余患者通过股动脉途径置入。该手术的主要并发症包括远端栓塞（n = 3），通过溶栓成功处理；1例通过腘动脉途径再通的患者发生腘动脉动静脉瘘，通过置入覆膜支架处理。在30天随访期内未发生与手术相关的死亡。所有患者术后平均随访12个月。在此期间，3例患者因相关内科疾病死亡。随访期间进行了以下截肢手术（3例截趾、5例前足截肢、3例膝下截肢、2例膝上截肢）。总体肢体挽救率为80%。
我们的研究表明，在伴有严重腘动脉以下疾病的糖尿病闭塞病变中，SFA/PPA支架置入具有有益效果。
