Jeans W D, Armstrong S, Cole S E, Horrocks M, Baird R N
Department of Radiology, Bristol Royal Infirmary, England.
Radiology. 1990 Nov;177(2):559-64. doi: 10.1148/radiology.177.2.2145608.
A prospective study of 370 patients who underwent 500 percutaneous transluminal angioplasties (PTAs) for lower-limb ischemia over a 7-year period was performed. A 97% follow-up rate was achieved. The first PTA was successful in 188 patients (51%). Of the failures, 31% were failed attempts at dilation and 73% occurred within 1 month of intervention. Of the patients with failed PTA, 39% underwent bypass surgery and 24% underwent amputation. The 30-day mortality rate was 3%, with 1% of the deaths attributed to PTA. The survival rate at 5 years for the successes was double that for the failures (P less than .0005). The best results were in femoropopliteal stenoses with two or three patent calf vessels (cumulative patency rate, 78% at 3 years) and the worst in femoropopliteal occlusions with one or no patent calf vessels (cumulative patency rate, 25% at 3 years). Log rank tests on the life-table data were used to show factors favoring a good outcome. It is concluded that PTA is the treatment of first choice in suitable patients and, although the failure of intervention in critical ischemia has a significant risk, it is a valuable addition to the therapeutic options in patients with little chance of surgical treatment.
对370例患者进行了一项前瞻性研究，这些患者在7年时间里接受了500次下肢缺血的经皮腔内血管成形术（PTA）。随访率达到97%。首次PTA在188例患者中成功（51%）。在失败的病例中，31%是扩张尝试失败，73%发生在干预后1个月内。在PTA失败的患者中，39%接受了搭桥手术，24%接受了截肢。30天死亡率为3%，其中1%的死亡归因于PTA。成功患者的5年生存率是失败患者的两倍（P小于0.0005）。最佳结果出现在有两条或三条小腿血管通畅的股腘动脉狭窄患者中（3年累积通畅率为78%），最差结果出现在只有一条或没有小腿血管通畅的股腘动脉闭塞患者中（3年累积通畅率为25%）。使用对数秩检验对生存表数据进行分析，以显示有利于良好预后的因素。得出的结论是，PTA是合适患者的首选治疗方法，尽管严重缺血时干预失败有很大风险，但对于手术治疗机会很小的患者来说，它是治疗选择中的一项有价值的补充。
