Park Sang Woo, Kim Jun Seok, Yun Ik Jin, Hwang Jae Joon, Lee Song Am, Chee Hyun Keun, Chang Seong-Hwan, Shin Dong Hyeok, Jung Hong Geun, Chang Il Soo
Department of Radiology.
Acta Radiol. 2013 Sep;54(7):785-9. doi: 10.1258/ar.2012.120217.
Diabetes mellitus tends to have the greatest impact on the smaller vessels and contributes significantly to occlusive disease from the popliteal artery distally.
To evaluate the clinical outcomes after a balloon angioplasty with or without stent placement in diabetic patients with critical limb ischemia (CLI) by chronic total occlusion (CTO) limited to below-the-knee (BTK) arteries.
From August 2005, patients who presented CLI and CTO limited to the BTK arteries, and who underwent endovascular treatment, were included in this study. The primary endpoints evaluated were technical success, limb salvage, and primary patency. The secondary endpoints evaluated were 30-day access site, intervention site, and systemic complications. Patency and limb salvage were evaluated using the Kaplan-Meier method and compared using Fisher's exact test.
The BTK endovascular treatment (EVT) was performed on 64 limbs. Technical success rate was 93.8% and limb salvage rate was 90.6%. Three of four limbs with technical failure and three of 60 limbs with technical success underwent BTK amputation and the comparison of these rates were significantly different (75% vs. 5%, P = 0.002). Primary patency rates for the limbs were 75% and 59.1% at 6-month and 12-month follow-up, respectively. Minor complications disappeared through the follow-up periods and there was no 30-day complication or systemic adverse events for the treated vessel.
Even though EVT for CLI in patients with diabetes and CTO in isolated BTK arteries does not have comparable primary patency, it can lead to a very high rate of limb salvage. This result can accentuate the importance of more blood flow to the foot by means of successful revascularization using EVT rather than long-term patency in CTO of isolated BTK arteries.
糖尿病往往对较小血管影响最大，并在很大程度上导致从腘动脉远端开始的闭塞性疾病。
评估在患有下肢严重缺血（CLI）且慢性完全闭塞（CTO）局限于膝下（BTK）动脉的糖尿病患者中，行或不行支架置入的球囊血管成形术后的临床结局。
从2005年8月起，将出现CLI且CTO局限于BTK动脉并接受血管内治疗的患者纳入本研究。评估的主要终点为技术成功率、肢体挽救率和初始通畅率。评估的次要终点为30天的穿刺部位、干预部位和全身并发症。使用Kaplan-Meier方法评估通畅率和肢体挽救率，并使用Fisher精确检验进行比较。
对64条肢体进行了BTK血管内治疗（EVT）。技术成功率为93.8%，肢体挽救率为90.6%。技术失败的4条肢体中有3条以及技术成功的60条肢体中有3条接受了BTK截肢，这些比率的比较有显著差异（75%对5%，P = 0.002）。随访6个月和12个月时，肢体的初始通畅率分别为75%和59.1%。轻微并发症在随访期间消失，治疗血管没有30天并发症或全身不良事件。
尽管针对糖尿病患者CLI且孤立BTK动脉CTO的EVT没有可比的初始通畅率，但它可导致非常高的肢体挽救率。这一结果凸显了通过成功的EVT血管重建增加足部血流的重要性，而不是孤立BTK动脉CTO的长期通畅。
