Modaghegh Mohammad-Hadi S, Hafezi Shahab
1 Vascular and Endovascular Surgery Research Center, Alavi Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Vasc Endovascular Surg. 2018 Feb;52(2):124-130. doi: 10.1177/1538574417744085. Epub 2017 Dec 13.
When critical limb ischemia (CLI) occurs in patients with thromboangiitis obliterans (TAO) or Buerger's disease, smoking cessation alone may be insufficient to relieve rest pain and promote wound healing. Accordingly, adjunctive measures are warranted to restore adequate blood flow required for limb salvage. This study aimed to evaluate the feasibility and efficacy of percutaneous transluminal angioplasty (PTA) for the treatment of patients with TAO and CLI. In addition, a review of the literature on endovascular management of TAO is included.
Between April 2012 and June 2017, all patients with TAO and CLI who underwent PTA were studied retrospectively. Patient demographics, presentation, procedural details, and clinical response were recorded. Patients were monitored at 1 week, 1, 2, 3, and 6 months after revascularization and at least every 6 months thereafter.
Thirteen patients with TAO and CLI, who presented with rest pain only (n = 1), ischemic ulcer (n = 4), or gangrene (n = 8) underwent endovascular interventions with primary and assisted primary technical success of 85% and 92%, respectively. A below-knee amputation was eventually done in the only patient with technical failure (limb salvage rate: 92%). Following the procedures, 11 patients had clinical response, one of whom also received intra-arterial vasodilator to achieve complete symptom relief. The other patient who failed PTA underwent a successful lumbar sympathectomy. In addition, all ulcers healed and eight minor amputations were performed due to already established gangrene. During follow-up (mean: 19.4 months), four patients needed reintervention. Patients who continued to smoke experienced more severe ischemia ( P = .017) and were more likely to require reintervention ( P = .009).
Percutaneous transluminal angioplasty can be considered as a technically feasible and potentially effective treatment for patients with TAO and CLI, as well as a last resort for limb salvage when other options have failed. However, reintervention may be required, especially in patients who continue smoking.
当血栓闭塞性脉管炎（TAO）或伯格氏病患者发生严重肢体缺血（CLI）时，仅戒烟可能不足以缓解静息痛并促进伤口愈合。因此，需要采取辅助措施来恢复肢体挽救所需的充足血流。本研究旨在评估经皮腔内血管成形术（PTA）治疗TAO合并CLI患者的可行性和疗效。此外，还包括对TAO血管内治疗文献的综述。
回顾性研究2012年4月至2017年6月期间所有接受PTA治疗的TAO合并CLI患者。记录患者的人口统计学资料、临床表现、手术细节和临床反应。血管重建术后1周、1、2、3和6个月以及此后至少每6个月对患者进行监测。
13例TAO合并CLI患者，仅表现为静息痛（n = 1）、缺血性溃疡（n = 4）或坏疽（n = 8），接受了血管内介入治疗，初次和辅助初次技术成功率分别为85%和92%。唯一技术失败的患者最终接受了膝下截肢（肢体挽救率：92%）。手术后，11例患者有临床反应，其中一例还接受了动脉内血管扩张剂治疗以实现症状完全缓解。另一名PTA失败的患者接受了成功的腰交感神经切除术。此外，所有溃疡均愈合，8例因已出现坏疽而进行了小截肢。在随访期间（平均：19.4个月），4例患者需要再次干预。继续吸烟的患者缺血更严重（P = 0.017），更有可能需要再次干预（P = 0.009）。
经皮腔内血管成形术可被视为治疗TAO合并CLI患者的技术可行且可能有效的方法，也是其他选择失败时肢体挽救的最后手段。然而，可能需要再次干预，尤其是在继续吸烟的患者中。
