Yuan Liangxi, Guo Songlin, Dong Jian, Zhou Jian, Lu Qingsheng, Bao Junmin, Jing Zaiping
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, P.R. China.
Diab Vasc Dis Res. 2017 Jul;14(4):310-315. doi: 10.1177/1479164117695682. Epub 2017 Mar 9.
The purpose of this study is to report the efficacy of endovascular treatment for patients with sub-acute (14-day to 2-month) deterioration of chronic lower extremity ischaemia.
Between June 2013 and May 2015, 26 consecutive patients (22 men, 4 women; mean age, 68.6 years; range, 50-86 years) were treated for sub-acute deterioration of chronic lower extremity ischaemia in our hospital. All patients were treated with catheter-directed thrombolysis initially and then adjunctive percutaneous transluminal angioplasty and/or stenting was performed to correct underlying lesions.
The 26 intra-arterial thrombolysis procedures were all performed in native lower arteries including 8 iliac, 13 femoropopliteal and 5 diffuse occlusions involving the iliac and femoropopliteal segments. Lesion length decreased from 194 mm (70-350 mm) to 92 mm (20-270 mm) after the thrombolytic procedures, and the residual lesions were corrected with percutaneous transluminal angioplasty alone in 4 (15.4%) limbs and stenting in 22 (84.6%) patients. No cross-joint stenting was seen in the 22 affected limbs that used stents. Throughout the treatment process, nine patients with intermittent claudication achieved an unrestricted walking distance, and 17 patients with rest pain or foot ulcers showed significant symptom improvement. The mean ankle-brachial index increased from 0.42 ± 0.16 preoperatively to 0.81 ± 0.25 postoperatively ( p < 0.01).
Endovascular therapy with catheter-directed thrombolysis and percutaneous transluminal angioplasty/stenting is feasible for sub-acute deterioration of chronic lower extremity ischaemia patients with favourable midterm results.
本研究旨在报告血管内治疗对慢性下肢缺血亚急性（14天至2个月）病情恶化患者的疗效。
2013年6月至2015年5月，我院连续收治26例慢性下肢缺血亚急性病情恶化患者（22例男性，4例女性；平均年龄68.6岁；范围50 - 86岁）。所有患者均首先接受导管定向溶栓治疗，然后进行经皮腔内血管成形术和/或支架置入术以纠正潜在病变。
26例动脉内溶栓手术均在下肢原生动脉进行，其中髂动脉8例，股腘动脉13例，累及髂动脉和股腘动脉段的弥漫性闭塞5例。溶栓术后病变长度从194 mm（70 - 350 mm）降至92 mm（20 - 270 mm），4例（15.4%）肢体仅通过经皮腔内血管成形术纠正残余病变，22例（84.6%）患者置入支架。在22例使用支架的患侧肢体中未见跨关节支架置入。在整个治疗过程中，9例间歇性跛行患者实现了不受限制的步行距离，17例静息痛或足部溃疡患者症状明显改善。平均踝肱指数从术前的0.42±0.16增加至术后的0.81±0.25（p < 0.01）。
对于慢性下肢缺血亚急性病情恶化患者，采用导管定向溶栓及经皮腔内血管成形术/支架置入术的血管内治疗是可行的，中期结果良好。
