Durham J R, Horowitz J D, Wright J G, Smead W L
Department of Surgery, Ohio State University College of Medicine, Columbus.
Ann Vasc Surg. 1994 Jan;8(1):48-53. doi: 10.1007/BF02133405.
Recent advances in balloon catheter technology allow percutaneous transluminal angioplasty (PTA) of small arteries such as the tibial arteries. PTA can thus be used to treat lower limb ischemia in diabetic patients whose arterial occlusive disease is often localized to the tibial arteries. This series included 14 consecutive diabetic patients who underwent tibial PTA for treatment of limb-threatening ischemia from 1986 to 1992. PTA was selected over conventional bypass procedures because of a lack of autogenous conduit or because of an unacceptably high surgical risk. Limb loss was imminent without prompt improvement in foot perfusion in all patients. Mean follow-up of 17 months demonstrated long-term limb salvage in 10/13 (77%) and "late" cardiac-related death in 3/13 (23%). This series demonstrates that although conventional arterial bypass should routinely supersede angioplasty procedures, tibial PTA offers the opportunity for limb salvage in diabetic patients with inadequate autogenous conduit for distal tibial bypass and may serve as an option for those who are considered too high risk for conventional bypass. Morbidity and mortality rates of tibial PTA parallel those of major amputation in this population with the obvious benefit of achieving limb salvage in carefully selected diabetic patients.
球囊导管技术的最新进展使得诸如胫动脉等小动脉的经皮腔内血管成形术（PTA）成为可能。因此，PTA可用于治疗糖尿病患者的下肢缺血，这类患者的动脉闭塞性疾病常局限于胫动脉。该系列研究纳入了1986年至1992年间连续14例接受胫动脉PTA治疗严重肢体缺血的糖尿病患者。选择PTA而非传统旁路手术是因为缺乏自体血管或手术风险高得难以接受。所有患者若不及时改善足部血供，肢体将会很快丧失。平均17个月的随访显示，13例患者中有10例（77%）实现了长期肢体保全，3例（23%）出现“晚期”心脏相关死亡。该系列研究表明，尽管传统动脉旁路手术通常应优先于血管成形术，但对于缺乏足够自体血管进行胫动脉远端旁路手术的糖尿病患者，胫动脉PTA提供了肢体保全的机会，对于那些被认为进行传统旁路手术风险过高的患者而言，这可能是一种选择。在该人群中，胫动脉PTA的发病率和死亡率与大截肢相似，其明显的益处是在精心挑选的糖尿病患者中实现了肢体保全。
