一种可靠的治疗糖尿病性神经缺血性足部伤口的方法：膝下节段血管腔成形术。
A reliable approach to diabetic neuroischemic foot wounds: below-the-knee angiosome-oriented angioplasty.
机构信息
Department of Vascular Surgery, Princesse Paola Hospital, Marche-en-Famenne, Belgium.
出版信息
J Endovasc Ther. 2011 Jun;18(3):376-87. doi: 10.1583/10-3260.1.
PURPOSE
To evaluate the clinical benefit in wound healing and limb preservation after primary below-the-knee angioplasty guided by an angiosome model of perfusion in diabetic patients with neuroischemic foot ulcers.
METHODS
From September 2001 to April 2010, 232 limb-threatening neuroischemic wounds in 208 diabetic patients (147 men; mean age 74.3 years, range 42-97) were treated by below-the-knee endoluminal and/or subintimal angioplasty. There were 19 (8%) TASC II type B, 80 (34%) type C, and 133 (57%) type D infrapopliteal lesions. Patients treated prior to 2005 when the angiosome-targeted revascularization protocol was introduced (89 limbs, group 1) were compared to 134 limbs treated subsequently according to the angiosome model (group 2). The angiosome-oriented group 2 included 25% procedures focusing on the anterior tibial and dorsalis pedis arteries, 68% on the posterior tibial and plantar vessels, and 7% on the peroneal arteries.
RESULTS
The global technical success was 80% (187/232): 82% in group 1 and 79% in group 2. The cumulative patient survival rates were 90%, 78%, and 65% in group 1 and 93%, 82%, and 71% in group 2 at 12, 24, and 36 months, respectively (p = 0.545). At the same time points, the freedom from amputation rates were 84%, 79%, and 79% in group 1 versus 90%, 89%, and 89% in group 2 (p = 0.035). Clinical success rates were 76%, 68%, 68% in the group 1 and 85%, 79%, and 79% in group 2 (p = 0.025). Primary and secondary patency rates did not differ between groups (p = 0.813 and p = 0.511). Patients in group 2 treated with angiosome-targeted revascularization had significantly better wound healing (p<0.018) and limb preservation (p<0.030).
CONCLUSION
Below-the-knee first-line angioplasty guided by an angiosome model may prove beneficial in terms of better wound healing of diabetic foot ulcers and subsequent limb salvage. Further technical improvements and large comparative studies are necessary to support these observations.
目的
评估基于灌注血管体模型的糖尿病伴神经缺血性足部溃疡患者一期膝下血管成形术的临床疗效，包括在伤口愈合和肢体保全方面的作用。
方法
2001 年 9 月至 2010 年 4 月，208 例糖尿病伴肢端威胁性神经缺血性溃疡患者（147 例男性；平均年龄 74.3 岁，范围 42-97 岁）接受了膝下腔内和/或次内膜血管成形术治疗。其中 19 例（8%）为 TASC II 型 B，80 例（34%）为 C 型，133 例（57%）为 D 型。比较在引入血管体靶向再血管化方案前（89 肢，组 1）接受治疗的患者（2005 年之前）与随后根据血管体模型（组 2）接受治疗的 134 肢患者。血管体定向组 2中，25%的手术集中在前胫骨和足背动脉，68%的手术集中在后胫骨和足底血管，7%的手术集中在腓动脉。
结果
整体技术成功率为 80%（187/232）：组 1 为 82%，组 2 为 79%。组 1 的患者存活率分别为 90%、78%和 65%，组 2 为 93%、82%和 71%，分别在 12、24 和 36 个月时（p = 0.545）。同时，组 1 的截肢免于率分别为 84%、79%和 79%，组 2 为 90%、89%和 89%（p = 0.035）。组 1 的临床成功率分别为 76%、68%和 68%，组 2 为 85%、79%和 79%（p = 0.025）。两组间一期和二期通畅率无差异（p = 0.813 和 p = 0.511）。接受血管体靶向再血管化治疗的组 2 患者的伤口愈合（p<0.018）和肢体保全（p<0.030）情况明显更好。
结论
基于灌注血管体模型的膝下一线血管成形术可能在改善糖尿病足溃疡的愈合和随后的肢体挽救方面具有优势。为了支持这些观察结果，需要进一步的技术改进和大规模的比较研究。
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