Faglia Ezio, Clerici Giacomo, Airoldi Flavio, Tavano Davide, Caminiti Maurizio, Curci Vincenzo, Mantero Manuela, Morabito Alberto, Edmonds Mike
1IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
Int J Low Extrem Wounds. 2012 Dec;11(4):277-85. doi: 10.1177/1534734612463701. Epub 2012 Oct 21.
Feasibility of revascularization of type D femoropopliteal and long infrapopliteal lesions by angioplasty (peripheral translumenal angioplasty [PTA]) in diabetic patients with critical limb ischemia (CLI) according to the TransAtlantic Inter-Society Consensus (TASC) II recommendations was studied. A total of 292 diabetic patients were admitted for CLI; 308 limbs underwent a PTA. Out of 211 femoropopliteal lesions treated with PTA, 44 were TASC II type A, 45 type B, 48 type C, and 76 type D lesions. In 44 of the 76 patients with type D lesions revascularized by PTA, no artery was patent down to the foot before the PTA. In 172 limbs with all infrapopliteal arteries occluded, revascularization was carried out down to the foot in 167 limbs. Follow-up was 3.1 ± 0.3 years. A first episode of restenosis occurred in 66/308 limbs with an incidence/year of 7.9. PTA procedures were successfully repeated in 57/66 restenosis episodes: secondary patency was 97.1%. The incidence/year of type D femoropopliteal lesions was 5.4, the incidence/year in others was 5.0, without statistically significant differences: P = .417. The only variable found significantly associated with restenosis occurrence on logistic analysis was the presence of lesions in both femoropopliteal and infrapopliteal axes. A total of 26/308 above-the-ankle amputations were performed, with an incidence/year of 2.5. Multivariate analysis showed the independent role of only crural artery occlusion after PTA. These data show that the choice to refer to angioplasty diabetic patients with type D and/or long infrapopliteal lesions without good run-off at the foot and/or high surgical risk allowed high revascularization feasibility, with an optimal amputation outcome.
根据跨大西洋两岸血管外科学会共识（TASC）II 建议，研究了血管成形术（外周血管腔内血管成形术 [PTA]）对患有严重肢体缺血（CLI）的糖尿病患者 D 型股腘动脉和长腘下病变进行血运重建的可行性。共有 292 例糖尿病患者因 CLI 入院；308 条肢体接受了 PTA。在接受 PTA 治疗的 211 个股腘动脉病变中，44 例为 TASC II 型 A 病变，45 例为 B 型，48 例为 C 型，76 例为 D 型病变。在通过 PTA 实现血运重建的 76 例 D 型病变患者中，44 例在 PTA 前足部无通畅动脉。在 172 条所有腘下动脉均闭塞的肢体中，167 条肢体实现了足部血运重建。随访时间为 3.1±0.3 年。308 条肢体中有 66 条首次发生再狭窄，年发生率为 7.9%。66 例再狭窄事件中有 57 例成功重复进行了 PTA 手术：二次通畅率为 97.1%。D 型股腘动脉病变的年发生率为 5.4%，其他病变的年发生率为 5.0%，无统计学显著差异：P = 0.417。逻辑分析中发现与再狭窄发生显著相关的唯一变量是股腘动脉和腘下动脉轴均存在病变。共进行了 308 例踝关节以上截肢手术中的 26 例，年发生率为 2.5%。多因素分析显示 PTA 后仅小腿动脉闭塞具有独立作用。这些数据表明，对于足部无良好流出道和/或手术风险高的 D 型和/或长腘下病变的糖尿病患者，选择血管成形术可实现较高的血运重建可行性，并具有最佳的截肢结局。
